Lok Sabha Question No. 4758 (UNSTARRED), answered on 2018-03-23
Subject: Delay in Payment to Empanelled Hospitals
Ministry: HEALTH AND FAMILY WELFARE
Asked by: RAJIV PRATAP RUDY

## GOVERNMENT OF INDIA MINISTRY OF HEALTH AND FAMILY WELFARE DEPARTMENT OF HEALTH AND FAMILY WELFARE

LOK SABHA UNSTARRED QUESTIO N NO. 4758 TO BE ANSWERED ON 23 rd MARCH, 2018

## DELAY IN PAYMENT TO EMPANELLED HOSPITALS

## 4758. SHRI RAJIV PRATAP RUDY:

Will the Minister of HEALTH AND FAMILY WELFARE be pleased to state:

- (a) whether there is a delay in the payment to empanelled hospitals under Government sponsored health programmes such as Central Government Health Scheme (CGHS) and Rashtriya Swasthya Bima Yojana (RSBY);
- (b) if so, the details thereof and the reasons therefor;
- (c)  whether  CGHS  and  RSBY  has been  effective  in  reducing  the  burden  of  out of  pocket spending of poor households, if so, the details thereof; and
- (d) the total number of beneficiaries and total funds allocated under CGHS and RSBY over the last four years, State/UT wiseincluding Bihar?

## ANSWER THE MINISTER OF STATE IN THE MINISTRY OF HEALTH AND FAMILY WELFARE (SHRI ASHWINI KUMAR CHOUBEY)

- (a) & (b): Under CGHS there is some delay in payment to empanelled hospitals. Following are the reasons for delay in settlement of hospital bills under CGHS: -
- Resource constraints particularly in the last quarter of Financial Year.
- Need for consultation with Specialists in some cases.
- Time taken in scrutinizing of Hospital bills.

Under  RSBY,  Insurance  Companies  make  payment,  as  due  and  admissible,  to  the empanelled hospitals as per their claim. Details are not maintained at Central level.

- (c): Under CGHS, the beneficiar ies, who are primarily Central Government Employees and Pensioners,      are  provided  health  facilities  including  OPD,  medicines,  reimbursemen expenditure  incurred  on  hospitalization  etc.  and  they  do  not  have  to  incur  out  of expenditure.  They  have to  bear  additional  expenditure  only  if  they  opt  for  specific  brand implants costing more than CGHS rates.

Under RSBY, claims amounting to Rs. 5012.17 Crore have been settled since 2011 - 12 to  2016 - 17,  which  may  be  construed  as  a  reduction  in  out  of  pocket  expenditure  for beneficiaries under RSBY, who have availed the hospitalization benefits.

- (d): There are 32,53,219 number of CGHS beneficiaries as on 13 .03.2018.

The total funds allocated under CGHS over the last four years is as under: -

| Year     |   Funds Allocated (Rupees in Crores) |
|----------|--------------------------------------|
| 2013- 14 |                              1772.75 |
| 2014- 15 |                              1734.02 |
| 2015- 16 |                              1872.29 |
| 2016- 17 |                              2026.91 |

Under RSBY no funds are allocated to States. Funds as central share of premium are released  on  receipt  of  proposals  from  State  Governments.  The  State - wise  list  of  beneficiaries under RSBY over the last four years including Bihar is at Annexure.

| RSBY Scheme: Statewise Status for last four years   | RSBY Scheme: Statewise Status for last four years   | RSBY Scheme: Statewise Status for last four years   | RSBY Scheme: Statewise Status for last four years   | RSBY Scheme: Statewise Status for last four years   | RSBY Scheme: Statewise Status for last four years   |
|-----------------------------------------------------|-----------------------------------------------------|-----------------------------------------------------|-----------------------------------------------------|-----------------------------------------------------|-----------------------------------------------------|
| S.No.                                               | State                                               | No. of Families Enrolled under RSBY                 | No. of Families Enrolled under RSBY                 | No. of Families Enrolled under RSBY                 | No. of Families Enrolled under RSBY                 |
| Year                                                | Year                                                | 2013-14                                             | 2014-15                                             | 2015-16                                             | 2016-17                                             |
| 1                                                   | Andhra Pradesh                                      | 2184                                                | *                                                   | *                                                   | *                                                   |
| 2                                                   | Assam                                               | 1416919                                             | 1421104                                             | 1421104                                             | 1421104                                             |
| 3                                                   | Bihar                                               | 6102774                                             | 818531                                              | 6899144                                             | 7028409                                             |
| 4                                                   | Chandigarh                                          | 5854                                                | 7865                                                | *                                                   | *                                                   |
| 5                                                   | Chhattisgarh                                        | 1962689                                             | 2141822                                             | 3442749                                             | 4146227                                             |
| 6                                                   | Gujarat                                             | 1900903                                             | 1876307                                             | 1876628                                             | 2691497                                             |
| 7                                                   | Haryana                                             | 463226                                              | 437850                                              | 437850                                              | *                                                   |
| 8                                                   | Himachal Pradesh                                    | 341818                                              | 481699                                              | 480588                                              | 480588                                              |
| 9                                                   | Jammu and Kashmir                                   | 4988                                                | *                                                   | *                                                   | *                                                   |
| 10                                                  | Jharkhand                                           | 1923138                                             | 1714552                                             | 1682894                                             | *                                                   |
| 11                                                  | Karnataka                                           | 29417                                               | 6050439                                             | 6731881                                             | 6206620                                             |
| 12                                                  | Kerala                                              | 2747029                                             | 2018764                                             | 2021572                                             | 2060802                                             |
| 13                                                  | Madhya Pradesh                                      | 608748                                              | 608748                                              | *                                                   | *                                                   |
| 14                                                  | Maharashtra                                         | 234252                                              | *                                                   | *                                                   | *                                                   |
| 15                                                  | Manipur                                             | 68140                                               | 70383                                               | 70925                                               | 70925                                               |
| 16                                                  | Meghalaya                                           | 108321                                              | 65840                                               | 256138                                              | 256138                                              |
| 17                                                  | Mizoram                                             | 145842                                              | 152983                                              | 152983                                              | 194886                                              |
| 18                                                  | Nagaland                                            | 151806                                              | 128184                                              | *                                                   | 255314                                              |
| 19                                                  | Orissa                                              | 4238040                                             | 4307538                                             | 4462959                                             | 4462959                                             |
| 20                                                  | Pondicherry                                         | 9486                                                | 6467                                                | *                                                   | *                                                   |
| 21                                                  | Punjab                                              | 236764                                              | 232352                                              | 232352                                              | *                                                   |
| 22                                                  | Rajasthan                                           | 2511663                                             | 2692626                                             | 2769097                                             | *                                                   |
| 23                                                  | Tripura                                             | 505327                                              | 505327                                              | 492022                                              | 481331                                              |
| 24                                                  | Uttar Pradesh                                       | 5541225                                             | 285435                                              | 285229                                              | *                                                   |
| 25                                                  | Uttarakhand                                         | 285435                                              | 3839765                                             | 1464242                                             | 285229                                              |
| 26                                                  | West Bengal                                         | 5748689                                             | 6063390                                             | 6150716                                             | 6290446                                             |
|                                                     | Grand Total                                         | 37294677                                            | 35927971                                            | 41331073                                            | 36332475                                            |

*  States not implementing RSBY during the period