Centre asks Delhi private hospitals to join Ayushman Bharat scheme

With the Delhi government refusing to be part of the Centre’s Ayushman Bharat health insurance programme, the National Health Agency has invited private hospitals to get empanelled with the Pradhan Mantri Jan Arogya Yojana to treat poor patients from across India.

delhi Updated: Nov 10, 2018 07:14 IST
Sanchita Sharma
Sanchita Sharma
Hindustan Times, New Delhi
Centre,Delhi,private hospital
Patients from other states account for 30-40% of patients treated in large Delhi hospitals. (HT?Picture for representation)

With the Delhi government refusing to be part of the Centre’s Ayushman Bharat health insurance programme, known as Modicare, the National Health Agency (NHA) has invited private hospitals to get empanelled with the Pradhan Mantri Jan Arogya Yojana (PM-JAY), one of the components of the overarching mission, to treat poor patients from across India who will be provided health insurance cover.

The invitation has gone to non-government hospitals in the capital that are accredited with the National Accreditation Board of Hospitals (NABH) . This follows the NHA’s invitation to all Central government hospitals in Delhi to join PM-JAY in September.

“Empanelling all Central hospitals, including those run by the Railways and defence services, will enable patients from across the country to avail of cashless treatment. Delhi gets many patients from other states, so we have also invited private hospitals in Delhi to get empanelled, provided they have NABH accreditation that ensures quality services and outcomes,” said Dr Jitu Lal Meena, deputy general manager, Hospital Network and Quality Assurance, NHA.

Patients from other states account for 30-40% of patients treated in large Delhi hospitals.

The National Capital Region centred on Delhi has 139 hospitals with more than 100 beds each accredited with the NABH, compared to 20 in Bihar, 26 in Odisha, 82 in Uttar Pradesh, and 80 in Madhya Pradesh, which are bigger and more populated states.

With 178 accredited large hospitals, Maharashtra has the most NABH-accredited hospitals, followed by Tamil Nadu with 177.

NABH-accredited hospitals in Delhi include Max Super Speciality Hospital, Saket; Sir Ganga Ram Hospital; Fortis, Shalimar Bagh; Fortis, Vasant Kunj, Moolchand Hospital; Delhi Heart and Lung Institute; Pushpawati Singhania Research Institute; Rajiv Gandhi Cancer Institute; Batra Hospital; Sitaram Bhartia Institute; and Primus Super Speciality Hospital, among others.

Ayushman Bharat offers cashless cover of up to ₹5 lakh for hospitalisation to 100 million poor and vulnerable families for 1,354 treatment packages. Delhi’s Aam Aadmi Party government has refused to be a part of the scheme, saying it would not cover enough people and that the state would work towards implementing its own health insurance instead.

Around 80% of India’s 1.04 million registered doctors of modern medicine (allopathy) work in the cities, home to 31% of the country’s population, according to data from the National Health Profile 2018. With public hospitals overburdened and understaffed, the success of the scheme relies on quality services offered by the private sector.

“Only 550 hospitals with more than 100 beds and 178 small hospitals have NABH accreditation, which tracks quality, training, infrastructure, infection control and treatment protocols to improve outcomes. Our estimate is there are at least 80,000 big and small hospitals in India, which means only 1% are accredited,” said Dr Girdhar J Gyani, director general, Association of Healthcare Providers India. “Small hospitals that cannot comply with all the NABH standards have the option of going for entry-level accreditation, which is given if one-third of the quality requirements are met,” he said.

To meet the shortfall of health providers, NABH, Quality Council of India in consultation Ministry of AYUSH has prepared a draft Pre-Accreditation entry-level standards for Ayush hospitals and invited comments and suggestions from the public, including stakeholders like hospitals and other clinical establishments, industry and consumer groups till November 15.

According to the Insurance Regulatory and Development Authority of India (Health Insurance) Regulations, 2016, “All such providers offering cashless services for allopathic treatment shall meet with the pre-accreditation entry level standards laid down by NABH or such other standards or requirements as may be specified by the Authority.”

“Getting accreditation, including a pre-entry level certificate issued by the NABH or a state-level certificate under National Quality Assurance Standards, helps hospitals get empanelled not just with AB-PMJAY but also with state health insurance schemes, such as Aarogyasri in Andhra and CM’s Comprehensive Health Insurance Scheme in Tamil Nadu,” said Dr Gyani.

First Published: Nov 10, 2018 07:14 IST