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The health ecosystem, in India, is witnessing a transformation. Health insurance is the fastest growing line of business in the insurance space to provide health care finance to a wide range of population.
The government of India moved from a sectoral, segmented & fragmented approach to health care delivery through various State/UT schemes converged with the flagship health insurance program Ayushman Bharat (PM-JAY) with more comprehensive and need-based service delivery of secondary & tertiary care to achieve Universal Health Coverage as its Sustainable Development Goal-3 (SDG3).
Worldwide, it is a recognized fact that health insurance schemes are prone to fraud, abuse, leakage & wastage which not only impact the schemes financially, but it also often led to endangering the health of beneficiaries of such schemes. Information asymmetry, as well as fraud and abuse either from the demand side or from the supply side of health care, makes the transactions...
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