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For uniform tariffs at hospitals, Irdai calls for regulatory powers or new body

Addressing the CII Insurance and Pensions Summit, Irdai Member (Non-Life) of TL Alamelu said, “We wish that there is a regulator or we are allowed to regulate hospitals.”

By: ENS Economic Bureau | Mumbai |
Updated: December 7, 2021 6:04:55 am
According to insurance sector officials, hospitals keep changing tariffs on a regular basis. There is no body to regulate them on tariff structure and grading.

With hospitals across the nation following different tariff structures, a top official of the Insurance Regulatory and Development Authority of India (Irdai) has proposed that either there must be a separate regulator for the healthcare segment or Irdai must be allowed to regulate hospitals.

Addressing the CII Insurance and Pensions Summit, Irdai Member (Non-Life) of TL Alamelu said, “We wish that there is a regulator or we are allowed to regulate hospitals.”

According to insurance sector officials, hospitals keep changing tariffs on a regular basis. There is no body to regulate them on tariff structure and grading. When Covid hit the country last year, patients were fleeced by some hospitals. Irdai does not allow insurance companies to raise premium each year; though there is a 10-15 per cent inflation of hospital charges at present.

Insurance company officials said Irdai currently doesn’t have the infrastructure to regulate hospitals. “As healthcare is a state subject, it’s going to be a tough proposition for Irdai to regulate the hospitals,” said one official. Even as the General Insurance Council — the representative body of 34 general insurers in India — had proposed uniform charges for Covid treatment, hospitals were charging different rates.

With the Delhi High Court and insurance regulator Irdai directing insurance firms to complete settlement of Covid claims within an hour after discharge, the Council had asked hospitals to submit all the patient discharge documents in one go without having to be reminded of the missing documents.

They were also advised to ensure billing at pre-agreed rates and provide justification with supporting medical records for any co-morbidities necessarily treated. However, this was not implemented by hospitals. The joint working group of the Irdai and the National Health Authority (NHA) had proposed a unique common hospital registry, empanelment process, grading of hospitals and package cost harmonisation to promote the standardisation and effective utilisation of health care infrastructure under the insurance programme.

At present, health care schemes and private insurance have individual hospital empanelment process, which replicates various activities and contributes to inefficiency and duplication of processes. “It is recommended to have common empanelment portal which can be utilised by all the schemes/insurance companies with standardised empanelment criteria (and) will be hugely beneficial with special focus on standard safety and quality parameters,” said the Report of Network Hospital Management, prepared by the Irdai-NHA joint working group.

Krishnan Ramachandra, Co-Chair, CII National Committee on Insurance and Pensions, said that “even with increasing penetration, we will need to factor for general and medical inflation and given that medical inflation operates significantly higher than CPI inflation, a correction cycle from a pricing standpoint will be needed.”

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