How Health Insurers Can Shift from Payouts to Prevention with AI

India’s health insurance sector has come a long way in offering financial protection during medical emergencies. But the underlying model remains largely reactive—someone falls ill, gets hospitalised, files a claim, and the insurer processes the payout. In FY2023–24, this reactive approach translated into over ₹83,000 crore disbursed in claims, underscoring both the cost burden of inpatient care (IPD) and the urgent need to explore more sustainable approaches.

With rising healthcare costs and evolving patient expectations, health insurers are at a crossroads. The next phase of evolution isn’t just about digitising claims or enhancing fraud detection—it’s about using data and technology to anticipate health needs and intervene earlier. Artificial Intelligence (AI) is fast becoming a foundational tool in reshaping healthcare strategies.

Worldwide, the healthcare AI market is projected to grow significantly, increasing from an estimated $11 billion ...