Health insurance and third party administrators: issues and challenges

Abstract

The Insurance Regulatory and Development Authority in India has paved the way for insurance intermediaries such as third party administrators (TPAs) to play a pivotal role in setting up managed healthcare systems. TPAs have been set up to ensure better services to policyholders and to mitigate some of the negative consequences of private health insurance. However, given the demand and supply-side complexities of private health insurance and healthcare markets, insurance internmediaries face inmmzenzse challenges. IRDA has defined the role of TPAs as one of managing claims and reimbursemrent. Their role in controlling costs of healthcare and ensuring appropriate quality of care is less well-defined.