From Paperwork To Paperless: AI Is Transforming The Way India Pays For Healthcare

By Gaurav Gupta

In recent years, especially after the pandemic onset, the healthcare industry has witnessed a new wave of transformation. However, one area that stubbornly remained slow to evolve is healthcare financing. Millions of patients across the globe, particularly in low and middle-income countries, grapple with accessibility and affordability challenges in medical care services.

According to recent stats, out-of-pocket expenses in the present healthcare scenario pushed over 55 million Indians into poverty, as only 36% of the population have adequate health insurance coverage. They often account for a large portion of healthcare costs that push the families into debt and delay treatments.

The traditional financial ecosystem, equipped with paperwork, slow decision making and exclusionary credit checks, often proves inadequate, mainly when speed and accessibility are the essence. Against this backdrop, artificial intelligence (AI) is emerging as a powerful force capable of reshaping the delivery of healthcare financing solutions.

Faster Financing

In the progressive technology landscape, AI has become the linchpin of transformative change. It not only makes financing faster but also smarter and more inclusive. By harnessing data from multiple sources, including health records, credit behaviour, income patterns and even smartphone usage, AI plays a crucial role in making instant and informed decisions at the point of care.  

In the healthcare scenario, AI leverages real-time intelligence that allows healthcare providers to provide tailored financial solutions on the spot, from zero-interest EMI plans and microloans to ensure that treatment is not delayed due to monetary constraints. Additionally, its ability to assess non-traditional financial indicators opens the door for underserved populations to access funds they were previously denied. With the integration of healthcare and fintech, AI is poised to become the bridge that connects patients to the care they need, exactly when they need it.

AI Behind Instant Credit 

The adoption of AI in healthcare is revolutionising the space with instant access to loans. It capitalises on a multi-agent architecture that streamlines the entire process from data ingestion to real-time decision making. Data collection agents swiftly interface with digital KYC tools like Aadhar and PAN and access credit bureau APIs to pull complete customer profiles in a mere few seconds.

Simultaneously, the risk scoring agents assess both the borrower’s creditworthiness and the clinic’s reliability using proprietary models. This helps the decision-making agents to apply lender-specific policies, dynamically adjust loan pricing tiers based on assessed risks. Subsequently, this enables hassle-free loan approvals with the elimination of paperwork and reduced human intervention.

Balancing Speed with Security and Fairness

AI enables lightning-fast healthcare financing decisions, and speed must never compromise security, fairness and accountability. Instant approvals and disbursals can only be considered meaningful when the patients and providers trust the system. That’s why robust audit trails are essential to make every AI-driven decision traceable, explainable and subject to review.

Higher levels of transparency help avoid algorithmic bias and build confidence among users. In tandem, AI underwriting becomes more mainstream, requiring India to need policy frameworks that balance innovation with oversight. Furthermore, to ensure ethical and inclusive healthcare financing, it is imperative to adopt Sandbox licensing, standardised data contracts and consumer protection mechanisms aligned with the long-term interests of patients.
Reaching Beyond Metros

The urban centres lead the adoption of AI-driven healthcare financing, while Tier 2 and Tier 3 towns represent the next frontier for growth and impact. The penetration of smartphones is exceeding 75% even in smaller cities, which demonstrates a significant opportunity to reach underserved populations through mobile-first and user-friendly platforms. 

Apart from this, conversational interfaces of AI, such as chatbots in local language, can simplify complex financial terms and guide patients through approval processes in real-time. These intuitive solutions improve accessibility and build trust in medical financing in non-metro cities. 

Diverse Demographics

With the rise of integrated health-fintech ecosystems, there is an increased personalisation, smarter risk assessment and expanded access across diverse demographics. This can result in greater personalisation, smarter risk assessment and expanded access across diverse demographics. 

However, there is a present need to evolve regulatory frameworks to evolve and strengthen data privacy measures to make AI a cornerstone of equitable healthcare access globally and a critical social impact tool. 

(The author is the CEO of CarePay)

Disclaimer: The opinions, beliefs, and views expressed by the various authors and forum participants on this website are personal and do not reflect the opinions, beliefs, and views of ABP Network Pvt. Ltd.

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