Amid rising healthcare costs and limited insurance coverage, Visit Health—India’s leading digital healthcare and OPD insurance platform—has partnered with the India InsurTech Association (IIA) to release a groundbreaking report titled “The Changing Landscape of OPD Insurance in India.” The report calls for urgent reform in outpatient department (OPD) insurance to tackle surging medical inflation, growing chronic illness burdens, and unsustainable out-of-pocket expenses.
With medical inflation in India at 14% and nearly 40% of total healthcare expenditure borne directly by households, the report argues that OPD insurance must be recognized as essential—not optional. “India cannot achieve universal health coverage without mainstreaming OPD insurance,” said Anurag Prasad, Co-founder of Visit Health, at the report launch in New Delhi. “Everyday medical expenses such as doctor visits, diagnostics, and medication are driving millions into financial distress.”
Bridging the OPD Insurance Gap
India’s OPD market is valued at $37.7 billion, yet insurance penetration in this segment remains under 0.1%. The report’s findings highlight significant unmet demand:
61% of employees use OPD benefits when offered through corporate programs.
Medicines account for over 60% of OPD costs.
Hypertension and cardiovascular diseases—major causes of illness and death—are rarely covered under existing insurance.
India’s overall insurance penetration is just 4% of GDP, far below countries like Taiwan (11.4%) and South Africa (11.3%).
Enablers for OPD Insurance Expansion
The report envisions a more inclusive future, backed by regulatory and technological advancements:
IRDAI’s “Insurance for All by 2047” roadmap.
The upcoming National Health Claims Exchange (NHCX), expected to reduce claim costs from ₹650 to ₹50.
Increasing use of telemedicine (1 in every 35 consultations) and AI-driven fraud detection, potentially cutting insurance fraud by 60%.
Strategic Recommendations for Stakeholders
The report urges insurers, employers, and policymakers to act:
Insurers should offer comprehensive OPD plans covering general medicine, mental health, pregnancy, and chronic care.
Employers should integrate OPD cover into wellness programs, as chronic illnesses account for 14% of working days lost.
Policymakers must enable inclusive frameworks that prevent fraud and support innovation.
Path to Equitable Healthcare
As OPD usage rose from 5% in FY21 to 20% in FY24, especially in Tier-2 and Tier-3 cities, digital platforms are becoming key drivers of access. Affordable, customizable health plans and wider hospital networks can bridge the gap, moving India closer to equitable and proactive healthcare for all.