AHPI UP West Chapter: Putting Patients Back at the Centre of Healthcare

By:--  Dr Anurag Mehrotra, Founder & Chairman, Siddh Multispeciality Hospital, Moradabad

Western Uttar Pradesh is fast emerging as one of North India’s most important healthcare belts. From Noida and Greater Noida to Meerut, Moradabad, Bareilly, Bijnor, Muzaffarnagar, Saharanpur, Ghaziabad, Bulandshahr, Hapur, Amroha and Rampur, millions of people now seek advanced medical care closer to home.

Yet, while hospitals invest in better infrastructure, technology and specialists, another crucial pillar of the ecosystem has not kept pace, the health insurance and TPA (Third Party Administrator) system. Increasingly, it feels misaligned with the interests of the very people it is meant to protect: patients.

It is in this context that the formation of the AHPI (Association of Healthcare Providers of India) UP West Chapter is both timely and necessary.

A growing mismatch between care and coverage

On the clinical side, India has made tremendous progress. Tertiary hospitals in tier-2 cities now offer complex cardiac interventions, stroke care, advanced gastro surgery, oncology, NICU and critical care. But on the financing side, the reality is sobering.

Over the past decade, medical inflation has risen sharply, estimates range between 12–14% per year. The cost of implants, consumables, skilled manpower, critical-care infrastructure and medical technology has increased substantially. Yet, in many cases, insurance package rates have remained stagnant for years.

The results are visible on the ground:

• Hospitals often struggle to provide the ideal consumables or technology within outdated package limits.
• Quality compromises become structurally imposed, not voluntarily chosen.
• Patients are caught between what is medically necessary and what is financially approved.

This is no longer a hospital-versus-insurer debate. It is a patient safety issue.

Claim rejections, delays and a trust deficit

Another worrying trend is the increasing claim rejection and arbitrary deduction at multiple stages, pre-authorization, during treatment and at final settlement.

For patients, this means:

• Delayed admissions and postponement of critical procedures
• Treatment interruptions while paperwork is “re-evaluated”
• Out-of-pocket payments despite having a valid policy
• Psychological stress at a time when families should be focused on recovery

For doctors and hospitals, this creates a constant tension: the best medical decision for the patient does not always align with what the insurer is willing to pay for, or when they will pay.

The black box of package pricing

One of the biggest structural problems is the lack of transparency around how package rates are set.

There is:

• No publicly explained cost model,
• No clear accounting for inflation,
• No reason why two similar hospitals in the same city should receive different reimbursement rates from the same insurer.

Moreover, India has no standardised rating system for TPAs and insurers. The behaviour of payors, their rejection rate, payment timelines, adherence to MoUs, and responsiveness to grievances, remains largely opaque to both patients and hospitals.

In other sectors, we have tools like CIBIL scores to bring transparency and accountability. Healthcare needs an equivalent framework for payors.

The silent strain of government schemes

While private insurance has its challenges, government schemes like Ayushman Bharat, ESIC and CGHS bring their own structural issues.

Package rates under these schemes are frequently far below actual treatment cost, especially for complex procedures and critical care. On top of that, payments are often delayed for months, with unexplained deductions and repeated queries. Many hospitals report that even the terms of officially signed MoUs, such as turnaround time (TAT) for payments, are not consistently honoured.

The intent behind these schemes is noble: to protect the poorest and most vulnerable. But without realistic pricing and timely payments, hospitals that treat large numbers of such patients find it increasingly difficult to sustain quality. Ultimately, the impact falls on the same communities these schemes were designed to help.

Why AHPI UP West Chapter matters

In this environment, individual hospitals, however committed, have limited leverage. What Western UP needs is a collective, credible and patient-focused voice.

The AHPI UP West Chapter aims to:

• Advocate for patient-centric insurance practices that are transparent and fair.
• Push for a standard payor rating system, tracking rejection rates, payment delays and grievance handling.
• Engage with regulators on minimum Medical Loss Ratios (MLR) so that a reasonable share of premium actually flows into patient care.
• Seek rationalisation of Ayushman/ESIC/CGHS packages, with realistic tariffs and timely, contract-bound payments.
• Strengthen hospitals so that they, in turn, can continue to deliver safe, high-quality care to patients in this region.

This is not about confrontation. It is about constructive, data-driven dialogue between hospitals, insurers, government bodies and citizens.

Putting the patient back at the centre

At its core, this movement is not about enhancing hospital margins; it is about protecting patients, their rights, dignity and access to the best possible care.

When reimbursement frameworks are rational and transparent:

• Patients can receive the right implant, the right drug, the right technology, without hidden financial shocks.
• Hospitals can plan and invest confidently in quality, technology and manpower.
• The overall system becomes more stable, predictable and trustworthy.

The creation of the AHPI UP West Chapter is therefore more than an organizational milestone. It is a moral and social responsibility.