Mumbai’s civic hospitals are set to undergo a digital overhaul as the Brihanmumbai Municipal Corporation (BMC) rolls out the Integrated Patients Healthcare Schemes Assistance (IPHSA) system. Here’s a closer look at IPHSA and how it will benefit patients, their families and BMC-run healthcare centres. What is IPHSA? IPHSA or Integrated Patients Healthcare Schemes Assistance is a technology-driven platform designed to serve as a single window for patient eligibility checks, enrolment in public healthcare schemes, and claim settlement. According to a senior BMC official, “Whatever is defined by the government authorities, whether it is the state government, the central government or the Employees’ State Insurance Corporation (ESIC), the system will verify and support automatically.” This means eligible patients can avoid multiple counters and endless paperwork, gaining access to Mahatma Jyotiba Phule Jan Arogya Yojana (MJPJAY), Ayushman Bharat-Pradhan Mantri Jan Arogya Yojana (AB-PMJAY), ESIC, and other key schemes at a single helpdesk. The system is also designed to integrate contributions from employees and employers for ESIC, ensuring that eligible patients are identified automatically when they visit hospitals. Why is it being introduced? Officials say IPHSA’s primary goal is to bridge the communication and administrative gaps that have often prevented low-income patients from receiving timely, cashless care. “The class we are catering to does not have any information, so only stringent criteria will ensure service delivery,” an official noted. By digitising the system, BMC aims to cut down delays, reduce bureaucratic burdens on staff, improve claim settlement cycles, and make hospitals financially sustainable. The policy is designed to enable civic hospitals to sustain operations from scheme revenues within five to eight years as capacity grows. It also seeks to reduce out-of-pocket expenditure for patients, especially those who previously had to approach multiple counters or were dependent on charitable funding for uncovered treatments. How will it work for patients? Patients will no longer have to pay upfront for medical procedures covered by government schemes. Whether the treatment is at major BMC institutions or PPP centres within civic hospitals, those found eligible will be registered and treated cashlessly. “There is no upfront payment for anything, even emergency services,” a BMC official confirmed. Documentation is verified digitally using Aadhaar and scheme IDs, and patient complaints can now be registered via a portal, which must be resolved before reimbursement. The system supports both emergency and elective treatments, with dashboards tracking every claim’s status in real time. This includes treatment in peripheral hospitals and specialty services like dialysis, MRI, and other investigations under the schemes, ensuring the patient experience remains completely cashless regardless of service location. What about hospitals and the financial model? From the hospital's perspective, IPHSA represents a major shift in accountability and timely payments. Claims are settled directly to BMC accounts, and all supporting documents are scanned and monitored centrally. Each geographic zone of Mumbai will have a separate service agency, selected not just for the lowest cost but for proven results and infrastructure. “Below 70 per cent coverage, you are not paying. This is why there is a chart for gradation in the tender itself,” said an official involved in procurement. Agencies stand to earn three to five per cent commission, but only if key metrics are met. Officials expect efficiency to jump by 40 to 50 per cent over the next few cycles, with transparent payment and data dashboards for hospital staff and city offices. Hospitals will also be able to track how many patients were treated under each scheme, total funds received, and expenses incurred for consumables and medicines, ensuring precise financial planning. What are the current challenges? Rollout will begin at major hospitals, but not all schemes are functional at every centre at present. Officials acknowledge that broad public awareness campaigns will follow the first phase of implementation. “For now, we are not actively going out. Once it is implemented and the system is streamlined, maybe in three or four months,” another administrator said. The system includes complaint redressal, open dashboard updates, and a dedicated helpline, especially for senior citizens, though it is not yet operational. Patient and hospital feedback will be monitored actively, and the scheme currently does not cover private hospitals, remaining focused on civic and public-sector partners. While a full awareness programme is pending, trained personnel will be deployed in hospitals to guide patients through the digital system, ensuring minimal delays in registration or service access. How are service providers selected? Agencies supporting IPHSA are appointed through an open, zone-wise tender, with contracts awarded according to quality-based selection, which evaluates previous experience, technical merit, and infrastructure. “So, in the tender itself, I have given a proper chart mentioning the matrix,” a BMC official explained. It is possible for one provider to win multiple zones, provided service levels are maintained in each, and their performance reports will be made publicly available. The tender matrix explicitly defines commission percentage according to coverage metrics, with full documentation and accountability required before payments are disbursed. Zoning also helps mitigate risk, and ensures that hospitals in each zone receive consistent service quality. Public access and accountability Patients will engage with hospital helpdesks for registration and scheme validation, while performance data and claim settlement rates will be posted on dashboards and city portals. Trained personnel are on-site to guide families through the digital system, and a helpline is in discussion. Each complaint logged through the portal must be resolved before funds are released. “If a person is not satisfied with the service, they can directly complain to the portal. Until the resolution of the complaint is done, they will not reimburse the claim amount,” explained a senior BMC official. The initiative is being geared for scale, with projections suggesting it will allow hospitals to absorb at least 20 per cent more patients by the end of the first year. Hospital staff are expected to face minimal bureaucratic hurdles, as the system centralises documentation and uses automated dashboards for claims and reimbursements. The road ahead The Mumbai civic body’s IPHSA marks the first time in Maharashtra that a single-window, government-backed healthcare portal is being rolled out citywide. Its success will depend on transparent implementation and sustained outreach to the city’s poorest residents. “This is something like giving autonomy to hospitals. Eventually, maybe the hospital can make its own decisions if it can sustain itself with its own revenue stream. Maybe in five, seven, eight years,” concluded the BMC senior official. With cashless access, real-time digital handholding, and accountable payments, officials hope IPHSA will ensure timely, equitable care for all municipal hospital patients in Mumbai. Once fully implemented, the system will also support detailed monitoring of revenue, patient coverage, and claim efficiency, giving hospitals autonomy to plan resources and expand services without financial bottlenecks.
