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Insurers and third party administrators must disclose specific medical infrastructure and quality parameters for network hospitals that provide cashless services. Insurers publish this data on their websites based on information valid as at 31st March every financial year. Third party administrators provide a link to the insurance company website where the information appears and also disclose the web addresses of the network providers. Insurers amend their service level agreements with network hospitals to ensure hospitals supply the required data. These directions take effect from 1st April 2021, and the data for the financial year ending 31st March 2021 is published by 30th June 2021.
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भारतीय बीमा विनियामक और विकास प्राधिकरण INSURANCE REGULATORY AND DEVELOPMENT AUTHORITY OF INDIA
Ref: IRDAI / HLT/CIR /MISC/145 /06/ 2020
10th June, 2020
To
All Insurers and TPAs,
Re: Standards for hospitals in the provider network – Disclosure of Quality Parameters
NAME OF THE HOSPITAL ------ ROHINI Id Address **Information as at -------- TABLE - A
| S No. | Medical infrastructure of the Hospital |
|---|---|
| 1 | Total Bed strength of the Hospital |
| 2 | Number of Doctors |
| 2a. | Total number of Full time doctors with qualification approved by MCI in the rolls of the Hospital? |
| 2b. | Number of consultants |
| 2c. | Number of surgeons or interventionists |
| 3 | Total number of qualified nurses in the hospital |
| 4 | Total number of intensive care unit beds in the hospital |
| 5 | Number of doctors (with Qualification of MBBS/MD) exclusively available for ICU |
| 6 | Number of qualified nurses available exclusively in the Intensive care Units taking all the shifts together |
| 7. | Accreditation received by the Hospital (Pre-entry level Certificate or higher level of certificate) issued by National Accreditation Board for Hospitals and Healthcare Providers (NABH) or State Level Certificate (or higher level of certificate) under National Quality Assurance Standards (NQAS), issued by National Health Systems Resources Centre (NHSRC)) (Details of Accreditation shall be provided). |
** The date as on which the data is valid, as received from the network provider, shall be stated by the insurer. Wherever the data is NIL the same shall be specified.
TABLE - B
| Parameter | Calculation |
|---|---|
| 1 | DOCTOR- BED RATIO |
| 2 | NURSE-BED RATIO |
| 3 | DOCTOR- BED RATIO IN ICU |
| 4 | NURSE- BED RATIO IN ICU |
| 5 | AVERAGE ADMISSION TIME |
| 6 | AVERAGE DISCHARGE TIME |
| 7 | AVERAGE LENGTH OF STAY (ALOS) FOR MEDICAL CASES |
| Denominator: Total number of medical inpatient discharges (during the last financial year) relating to insurer | |
| (As per the calculation of Insurer taking into account all the respective admitted cases in the preceding financial year.) | |
| excluding day care treatment like chemotherapy, radiotherapy dialysis etc | |
| 8 | AVERAGE LENGTH OF STAY (ALOS) FOR SURGICAL CASES |
| Denominator: Total no. of discharges of surgical cases relating to insurer | |
| (As per the calculation of Insurer taking into account all the respective admitted cases excluding day care treatment like chemotherapy, radiotherapy dialysis etc .) | |
| 9 | C_SECTION RATE |
| Denominator: Total births(number of deliveries) in the hospital in same time period relating to insurer | |
| x100 | |
| (As per the calculation of Insurer taking into account all the respective admitted cases in the preceding financial year.) |
7L Me (T L Alamelu) Member (Non Life)
