In order to check the menace of inflated bills and other such irregularities in providing treatment under cashless insurance schemes (CIS), the Insurance Regulatory and Development Authority (IRDA) has directed all hospitals empanelled with it to provide treatment under CIS, to register themselves with the National Accreditation Board for Hospitals and Healthcare Providers (NABH) and comply with the norms laid down by the NABH.
IRDA is an autonomous apex statutory body that regulates the insurance industry in India, while the NABH is a constituent board of the Quality Council of India (QCI), set up in 2006 to accredit and guide the programmes for healthcare organisations.
“All hospitals 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 from the authority from time to time within a period of two years from the date of notification of these guidelines,” a notification of IRDA reads. The new changes in the guidelines of IRDA have directed hospitals to obtain the NABH’s entry-level certificate that is valid for a two-year term. Gagandeep Nath, a member of NABH, told The Sunday Guardian: “Earlier, the NABH’s accreditation was completely voluntary and only a few hospitals had registered themselves with it. Now, it has been made mandatory, which is an important step to ensure the quality of treatment and fair billing process in hospitals across the country. Hospitals have to meet the basic requirements at the entry level accreditation of NABH to be able to empanel themselves under various insurance schemes.”
“As of now across the country, only 450 hospitals are registered with NABH. With the new changes, NABH will also keep tabs on the inflated bills raised by hospitals for patients availing treatment under the cashless schemes,” Nath added.
Jyoti Sharma, another NABH member, said, “The NABH guidelines are simple and basic, like maintaining hand hygiene facilities, monitoring infection rates in hospitals, comparative uniformity in billing etc. Patients are consumers and if they are spending money, they have all right to avail the best quality treatment,” Sharma told The Sunday Guardian.
“However, NABH can’t take any action if a hospital fails to comply with the norms, except writing letters and recommendations to IRDA for any such thing. With IRDA’s strict move, I think hospitals will come forward to follow the guidelines of NABH,” Sharma added.
Insurance companies are also happy with the decision of IRDA as mandatory accreditation of NABH will provide a healthy atmosphere for them to work in. Also, hospitals will be bound to keep uniformity in raising bills for patients for treatment under cashless schemes.
Stakeholders in the industry say that it is not only good for patients, but also for the hospitals, since it certifies that the hospital is a safe place to work for insurance companies. The entry-level rules are very basic and fundamental and expected to be followed by all hospitals.
Bharat Kumar, a dealing officer of LIC, said: “Cashless schemes are becoming a lifeline for crores of Indian middle class people and in this scenario, the NABH can play the best role in ensuring the rules of the game which benefit all stakeholders.” “Hospitals need to pay Rs 20,000-25,000 for obtaining NABH’s certificate. Currently, there is no quality parameter set by the IRDA, hence, the initiative of mandatory quality certification of NABH is a good step, especially for hospitals in remote areas that have no quality parameters,” Kumar added.