Empanelment Of Hospitals Under AB-NHPM To Start In July As Govt Solves Payment Related Issues

New Delhi, 9 June 2018: The empanelment of hospitals under the Ayushman Bharat-National Health Protection Mission (AB-NHPM) through state governments is expected to start in July as the Central government has sorted out issues related to hospital bill payments. Recently, some private hospitals have raised objections in a letter written to the government saying that majority of top hospitals in the country won't participate in the insurance scheme as the rates fixed for surgeries and procedures are too low. The issue would be resolved as according to a new policy adopted by the Union health ministry, hospitals in different states will be paid differently for various surgeries and procedures. 

The scheme, cleared by the Cabinet recently, has the benefit cover of Rs.5 lakh per family per year. The target beneficiaries of the proposed scheme will be more than 10 crore families belonging to poor and vulnerable population based on Socio-Economic Caste Census database. AB-NHPM will subsume the on-going centrally sponsored schemes such as Rashtriya Swasthya BimaYojana (RSBY) and the Senior Citizen Health Insurance Scheme (SCHIS).

The government recently has decided to allocate Rs.10,000 crore initially to implement the AB-NHPM. According to health minister JP Nadda, the amount is flexible and will be used to cover costs of setting up technology systems and verifying entitled beneficiaries in addition to paying premiums to states that are implementing the scheme through insurance models. 

As per the new policy, the rates for hospital procedures are increased by 11-15 per cent than what was proposed in the tender floated earlier.

The revised policy also says that performance linked- payment system has been designed to incentivise hospitals to continuously improve quality and patient safety based on successive milestones.

“Hospitals qualifying for National Accreditation Boards for Hospitals and Healthcare Providers entry-level accreditation will receive an additional 10 per cent while those qualifying for full accreditation will receive an additional 15 per cent,” the new policy states.

It adds that to promote equity in access, hospitals providing services in backward districts will receive an additional 10 per cent. In addition, states have the flexibility to increase rates up to 10 per cent or reduce them as much as needed to suit local market conditions.

“Further states could retain their existing package rates even if they are higher than the prescribed 10 per cent flexibility slab,” the new norms stated. Pharmabiz