Lok Sabha Question No. 4000 (UNSTARRED), answered on 2019-01-04
Subject: Exorbitant Charges by Private Hospitals from Insured Patients
Ministry: HEALTH AND FAMILY WELFARE
Asked by: DARSHANA VIKRAM JARDOSH

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

LOK SABHA UNSTARRED QUESTION NO. 4000 TO BE ANSWERED ON 04 TH JANUARY, 2019

## EXORBITANT CHARGES B Y PRIVATE H OSPITALS FROM INSURE D PATIENTS

## 4000. SHRIMATI DARSHANA VIKRAM JARDOSH:

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

- (a)  whether  the  Government  proposes  to  take  corrective  measures  to  solve  the  problem inflated bills of insured patients, who at the time of a dmissions have to inform the hospital about having a mediclaim policy;
- (b) whether the Government proposes to roll out any plan for third party inspection on the of mediclaim and also take punitive measures against the erring hospitals charging ex orbitant amount; and
- (c) the other steps taken by the Government to control various types of exorbitant expendi the health sector, if so, the details thereof?

## ANSWER THE MINISTER OF STATE IN THE MINISTRY OF HEALTH AND FAMILY WELFARE ( SMT. ANUPRIYA PATEL )

- (a)  Health is a State subject.  Therefore, taking corrective measures regarding bills of insured patients falls within the domain of State/UT Governments. Also, a Insurance  Regulatory  and  Development  Authority  of  India  (IRDAI)  (Third  Party A dministrators - Health  Services)  2016,  it  is,  inter  alia,  specified  that  as  part agreement amongst Insurers, Network Providers and TPAs, all the TPAs and Insurers shall  endeavour  to  agree  with  the  network  providers  for  display  of  rates  agree rend ering  various  health  services  to  policyholders.  It  is  further  specified  t Insurers  and  the  TPAs shouldput  in  place  measures  for  passing  on  the  benefit  of discounts received, if any, from hospitals to the policy holders. It is envisaged above norms promote the fair practices by the Hospitals and enhance the transparenc
- (b) & (c) : No such proposal is under consideration this Ministry.

Contd……

Health  being  a  State  subject,  it  is  the  responsibility  of  respective  St Government to take measures to regulate exorbitant expenditure in the healthcare taking appropriate action against clinical establishments as per the Act/Rules app in the State/UT.

The  Government  of  India  has,  however,  enacted  the  Clinical  Establishment (Registration  and  Regulation)  Act,  2010  for  registration  and  regulation  of  all establishments in the country. Under the Clinical Establishments (Central Governm Rules,  2 012  notified  under  this  Act,  the  clinical  establishments  (in  the  States Territories where the said Act is applicable) are inter - ali  required to display their rates at a conspicuous place and charge the rates for each type of procedures and service s within the  range  of  rates  determined  from  time  to  time  in  consultation  with  the Governments.  The National Council for Clinical Establishments has approved a standard list of medical procedures and a standard template for costing of medical procedu res and the same has been shared with the States/UTs where the Act is applicable for appro action. The implementation and enforcement of the said Act is within the purview o State/UT  Governments.  Currently,  the  Act  is  applicable  in  11  States  and all  Union Territories except Delhi. Other States may adopt the Act under clause (1) of Arti of the Constitution.

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