70% of Indian Healthcare Spend Is OPD — But 90% of Insurance Ignores It
By Arunima Rajan
In an interview with Arunima Rajan, Gaurav Dubey, Founder and CEO of LivLong 365 talks about why OPD insurance matters in India. He points out that OPD insurance is not a nice-to-have, it’s a necessity for everyday healthcare.
You’ve called Livlong 365 India’s leading OPD insurance and health-tech platform. Let me start with the basics: why OPD? What did you see in outpatient care that everyone else either missed or chose to ignore?
In India, health insurance has traditionally focused on hospitalization, leaving everyday medical costs uncovered. Yet, if you look at how people actually spend on healthcare doctor consultations, diagnostics, medicines most of it happens outside hospitals. This is where the Outpatient Department (OPD) becomes not just relevant, but essential.
Nearly 70% of healthcare expenses in India arise from outpatient care like consultations, diagnostics and medicines, yet traditional insurance products in India were designed almost entirely around hospitalization. This caused a huge gap between what people were spending on and what insurance was actually covering.
For us at Livlong 365, OPD cover wasn’t just a product opportunity, it was a fundamental reimagination of healthcare financing. By focusing on OPD, we are not just solving for affordability, but also accessibility. We’re ensuring that healthcare becomes an ongoing relationship, not a one-time transaction. That’s the real shift, moving from care due to hospitalization to preventive healthcare.
Insurance has always been about hospitalisation in India. When you tell people that you can insure their OPD visits, isn’t there skepticism? How do you break that mental barrier?
Absolutely, there is initial skepticism because insurance in India has traditionally been equated with hospitalization. But the reality is, people spend far more on OPD like doctor visits, medicines and diagnostics rather than on hospitalization.
OPD cover is ideally designed to manage everyday healthcare expenses which are often left uncovered. It usually covers doctor consultations, diagnostic tests, medicines, minor medical procedures and therapies like physiotherapy or psychiatric counseling. This type of coverage can either be offered as a standalone plan, an add-on with an existing policy or as a modular insurance policy.
The financial advantages are both immediate and practical. OPD coverage provides either partial/full reimbursements or cashless options through partnered pharmacies and clinics across a wide network. In addition to this, most OPD plans allow filing of multiple claims in a given policy year, unlike traditional policies that mostly cover hospitalization. This flexibility makes OPD cover more aligned with the frequency and nature of routine healthcare needs.
Through demonstrating real value & showing customers that OPD coverage is not a ‘nice-to-have’ but a necessity, the perception shift can happen slowly but naturally.
You claim DIY OPD claims get settled in under four hours. I want to understand the backend: is this technology really doing the heavy lifting, or is there still a human layer that makes it possible?
Our OPD claim settlement process is powered primarily by technology which is AI-driven validation, automated workflows, and seamless integrations with pharmacies, labs, and clinics. This ensures accuracy, speed, and transparency. That said, we do maintain a lean human oversight layer for exceptions or complex cases, so customers always have the confidence of both tech efficiency and human assurance. It’s the balance that allows us to consistently deliver claim settlements in under four hours.
You’ve built fraud and abuse checks into your system. In a country where healthcare fraud runs deep, what makes you confident these safeguards won’t get gamed tomorrow?
At Livlong 365, our constant endeavor is to minimize fraud and abuse through robust, evolving controls. Our Fraud, Waste, and Abuse (FWA) framework is dynamic and monitored/reviewed continuously to analyze claims data & identify unusual utilization trends, investigate anomalies and implement corrective actions. These interventions may involve enhancements to our platform, client communications or operational SOPs. In parallel, we are leveraging AI-based claims prompts to strengthen adjudication and gradually move towards auto-adjudication with higher accuracy.
While fraud risk can never be eliminated entirely, we are confident that our proactive governance, rigorous monitoring, and technology-led safeguards enable us to detect issues early and act decisively, ensuring trust and transparency for all stakeholders.
The Regard Elderly Care Program sounds ambitious. But senior care is messy—medical, emotional, even cultural. How do you avoid this becoming just another checkbox benefit and actually make it meaningful for families?
The Regard Elderly Care Program was launched to address the comprehensive healthcare needs of the elderly by providing not just services, but a safety net. The program ensures preventive care, continuous monitoring, and timely intervention during emergencies, offering families peace of mind.
At the core is a dedicated Healthcare Manager (HCM) assigned to each elder. The HCM acts as a single point of contact coordinating regular check-ups, maintaining health records, arranging monthly doctor consultations, and managing emergencies. Monthly health updates are also shared with family members, covering vital signs, key biomarkers, and recommendations for lifestyle changes, treatments, or further tests.
Built on three pillars medical continuity, emotional support, and cultural sensitivity the program goes beyond clinical care. By blending healthcare with compassion, Regard ensures elders receive holistic support while families stay connected and reassured. This is not a checkbox service, but a meaningful system that improves life quality for elders and their loved ones.
Your service stack covers everything from doctor consultations to corporate wellness. Isn’t there a risk of spreading too thin? How do you decide what to own and what to partner on?
At Livlong 365, we position ourselves as an integrated healthcare solutions platform, not a fragmented service provider. Our role is to bring together the full spectrum of healthcare like consultations, diagnostics, medicines and insurance under one ecosystem. As an aggregator, we focus on building the right partnerships, ensuring clinical governance, and delivering solutions that are both effective and affordable. We retain ownership of what truly defines us like customer experience, quality assurance and compliance, while actual care delivery is entrusted to certified medical practitioners. This balance allows us to scale meaningfully without diluting focus, which is reflected in our consistently high customer satisfaction scores.
Health-tech in India is littered with startups that began with a bang and fizzled out. What are you doing differently so that Livlong 365 doesn’t become another cautionary tale?
It’s true, health-tech in India has seen many promising starts that couldn’t sustain. At Livlong 365, we’ve been deliberate about building for longevity, not hype. Our model is anchored in solving real gaps like insurance, OPD solutions and elderly care, backed by robust partnerships, strong unit economics and scalable tech. We are not chasing vanity metrics, we are building a healthcare ecosystem that delivers measurable value to customers and partners.
We’ve built scale by working at the grassroot level through a robust distribution network, which keeps our customer acquisition efficient and marketing spends lean. This allows us to maintain positive unit economics while growing sustainably. Equally important is our strong focus on customer service, reflected through the consistently high CSAT scores and high customer and partner retention. That’s what makes us confident we’re here to endure, not fade.
And finally, let’s look five years out. If Livlong 365 succeeds, what will have changed in the way ordinary Indians think about healthcare access and costs? And if it fails, what do you think the obituary will say?
If Livlong 365 succeeds, we envision a future where OPD and preventive care are fully formalized in India—supported by structured, regulated products that meaningfully reduce out-of-pocket expenses and promote proactive health management across the country.
Over the last four and a half years, the strong traction and customer appreciation we’ve received only reinforce that the time for OPD products is now. With an aging society and a rising burden of hospitalizations, shifting the focus to preventive and outpatient care isn’t just relevant, it’s imperative for the sustainability of our healthcare system.
And if we were to fail, I hope the obituary would read that Livlong 365 was ahead of its time, that we dared to challenge the traditional model of health insurance and sparked a conversation that others eventually carried forward. But we are deeply committed to ensuring that this vision does not remain unfinished.
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