Rajasthan's government health scheme has Rs 1,000 crore in pending dues to hospitals. Pensioners and retired employees, the very people the scheme was designed to protect, are being asked to pay out of pocket at the hospitals where they went expecting cashless care. Some hospitals have simply stopped treating scheme patients.
This is not a story about one state or one scheme. Bihar, Andhra Pradesh, Punjab, Haryana. The numbers differ. The pattern does not.
Each time it happens, the conversation focuses on when the government will release funds. That is the wrong question. The right question is why private capital is not already standing in the gap.
India built the platform. It just left out one feature.
The National Health Claims Exchange, NHCX, is one of the most significant pieces of digital public infrastructure India has built in recent years. Every cashless claim processed through it generates a structured, machine-readable, government-authenticated record. The insurer reviewed the claim. The treatment is verified. The payment obligation is confirmed. The amount is on record.
That record is, in financial terms, among the most credible short-term obligations in the Indian economy. The payer is either an IRDAI-regulated insurer or a government health scheme with sovereign backing. The claim has cleared adjudication. There is no credit ambiguity. There is only a timing gap between approval and actual payment.
NHCX was designed to solve the adjudication problem. It is doing that. What it was not designed to do is connect that verified obligation to the financial system. There is no mechanism today for a bank or NBFC to look at an NHCX-approved claim and act on it. Not because the data is unavailable. Because the platform was never given a financing role.
That is the missing feature.
What private capital needs to step in
Private capital does not stay away from healthcare financing because it dislikes the asset. It stays away because it cannot price the risk. And it cannot price the risk because it cannot see the claim.
A financier considering a loan to a hospital in Jaipur today sees an SME with a stressed balance sheet. It does not see Rs 5 crore in approved, undisputed claims from a state government health scheme sitting in a portal somewhere. Those claims do not show up in the hospital's financials in a way a lender can act on. They are not verified by any system the lender can query. They are not date-stamped with a confirmed payment timeline. They are invisible to the financial system.
So the lender prices for the risk it can see, which is a small hospital with uncertain cash flows, and ignores the risk it cannot see, which is actually very low. The rate comes out at 20 percent. The hospital pays it because it has no choice.
If NHCX were to open a read-only financing window, the entire equation changes. A financier can query a specific claim and confirm: this claim exists, it was approved on this date, for this amount, by this insurer or state agency, and it has not been funded by anyone else. That is all the information needed to price the transaction correctly. The risk is the insurer's or the state government's credit, not the hospital's. The rate that reflects that risk is a fraction of what hospitals pay today.
"Private capital does not need a subsidy to fund government-approved health claims. It needs visibility. NHCX already has the data. It just has not been asked to share it with the financial system."
One platform, one new role
NHCX does not need to become a bank. It does not need to lend money or take on any financial risk. It needs to do one thing it does not do today: confirm, to an authorised financier, that a specific approved claim is genuine, undisputed, and unfunded.
That confirmation, delivered through a secure API, with patient data stripped at the gateway, converts a piece of information sitting inside a government system into the foundation for a competitive financing market. Banks and NBFCs bid against each other to fund low-risk, government-backed obligations. Rates fall. Hospitals access capital at costs that reflect the true quality of what they have earned. The payment gap gets funded by private markets rather than absorbed by hospital balance sheets.
The Rajasthan situation is not going to be the last of its kind. As health insurance coverage expands, as more patients enter cashless schemes, the volume of approved claims waiting for payment will only grow. Every rupee of that approved obligation is potential collateral for private capital, sitting unused because the platform that verified it was never connected to the system that could fund it.
NHA built NHCX to bring transparency and speed to healthcare claims. The next step is to let that transparency do more than move claims from hospitals to insurers. Let it move capital to hospitals that have already earned it. The data infrastructure is in place. The decision to use it is not a technical one. It is a policy one. And the case for making it gets stronger every time another state's hospitals stop treating patients because the money they are owed has not arrived.