Hospitals accredited with the nation’s accreditation authority may get more funds for offering medical treatment under the recently announced comprehensive health insurance scheme, a member of the government’s Niti Aayog policy think tank said.

Since hospitals certified by the National Accreditation Board for Hospitals (NABH) are supposed to provide quality care, Niti Aayog is considering helping them out financially as such care involves high costs.

Another reason is that the government has not included Out Patient Department (OPD) costs in the National Health Protection Scheme (NHPS) scheme, dubbed Modicare, for consultations in private hospitals.

“We have prepared over 1,000 packages for NHPS for providing tertiary medical care to patients. The NABH-accredited hospitals certainly have better quality of services in comparison to non-accredited hospitals. The cost incurred on treatment of patients in these hospitals will certainly be high in comparison to other hospitals," said V.K. Paul, member (health and nutrition) Niti Aayog.

The process of accreditation is administered by the Quality Council of India (QCI), a national healthcare accreditation and quality improvement body that functions at par with global benchmarks. It operates accreditation and allied programs in collaboration with stakeholders focusing on patient safety and the quality of healthcare, based upon national and international standards, through a process of self and external evaluation.

NABH accreditation also provides an objective system of empanelment by insurance and other third parties. Accreditation provides access to reliable and certified information on facilities, infrastructure and level of care. Currently over 350 hospitals in India are accredited with NABH. Niti Aayog is in talks with the QCI to facilitate services under the NHPS. “The process is underway. Nothing has been finalized yet. Once something works out in this matter, then only we will be able to divulge any details," said Harish Nadkarni, CEO, NABH, QCI.

OPD costs are not covered in any of the packages of the NHPS, described as the world’s largest health protection cover, which means the poor will continue to bear Out of pocket expenditure (OoPE) on OPD consultations and medicines.

“So far, there is no package to cover OPD expenses, though over 70% of out of pocket expenditure by poor is on to treatments availed in OPDs and purchasing medicines. Other reasons are loss of wages due to illness, transportation etc. but around 30% is on catastrophic expenditure in case of admission into a hospital for critical disease such as cancer or kidney failure. NHPS will save poor people from catastrophic expenditure on treatment, which has a major impact on people financial situation," said Paul.

“We are also planning to provide medicines for the full course of treatment for the patients even after they are discharged from a hospital. The government is trying to cover consultation and medicines through various other schemes such as Pradhan Mantri Bhartiya Jan Aushadhi PariYojana Kendra (PMBJPK)," he added.

Most patients reaching out to private hospitals and diagnostic centres end up incurring OoPE in a bid to avail quality services, the Economic Survey 2018 said last month. The expenditure by government healthcare providers accounted for only 23% of the Current Health Expenditure, the survey report said.

The share of OoPE is 62%, as per the National Health Accounts (NHA) 2014-15. The findings of Household Health Expenditure survey revealed that about 10% of OoPE on health was spent by households on diagnostics and medicines during 2013-14.

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