Delay in Payment to Empanelled Hospitals

GOVERNMENT OF INDIA
MINISTRY OF HEALTH AND FAMILY WELFARE
LOK SABHA

UNSTARRED QUESTION NO: 4758
ANSWERED ON: 23.03.2018

Delay in Payment to Empanelled Hospitals

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 wise including 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:-

i. Resource constraints particularly in the last quarter of Financial Year.
ii. Need for consultation with Specialists in some cases.
iii. 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 beneficiaries, who are primarily Central Government Employees and Pensioners, are provided health facilities including OPD, medicines, reimbursement of expenditure incurred on hospitalization etc. and they do not have to incur out of pocket expenditure. They have to bear additional expenditure only if they opt for specific brand of 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 the 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.

Annexure:-

RSBY Scheme: Statewise Status for last four years
S.No.	State	No. of Families Enrolled under RSBY
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

Source : LokSabha