Private hospitals have opposed the Ayushman Bharat treatment package rates proposed by the Union health ministry that plans to roll out the flagship medical insurance scheme within months.
Hospitals argue that government rates are too low to recover the procedure cost they would incur in treating the patients. In many cases, the proposed costing is lower than the central government health scheme (CGHS) rates that were last fixed in 2014.
“The apprehension expressed by one and all regarding the package rates for the various procedures is that it is abysmally low, and even with the potential 30-40% increase possible, there is a significant gap between the reimbursement and the actual cost. There is no question of making a profit out of it,” Alexander Thomas, president of the Association of Healthcare Providers (India) wrote to Niti Ayog member Vinod Paul on Tuesday.
The association asked the ministry to follow the method adopted by the Karnataka government to determine the cost prices of various treatment packages.
The southern state tasked Indian Institute of Management, Bengaluru and National Accreditation Board for Hospitals and Healthcare Providers for the job. The AHPI claims that the rate chart prepared by the IIM-NABH team are more realistic.
In case of heart bypass surgery, Karnataka price is Rs 1,88,231 whereas CGHS would reimburse Rs 1,12,770 for the same. Under the Ayushman Bharat National Health Protection Mission, cost of the same surgery has been fixed at Rs 1,10,000.
For total knee replacement, the cost in Karnataka is Rs 1,98,207 as against CGHS rate of Rs 1,49,100 and Ayushman Bharat rate Rs 80,000. Similarly, on hysterectomy for cancer, Karnataka rate is Rs 1,45,143 as against CGHS and Ayushman Bharat cost of Rs 78,370 and Rs 50,000 respectively.
“We want rationalisation of the rates for sustainability of hospitals as the government wants to rope in nearly 20,000 hospitals. The package rates should take into account both direct and indirect costing,” Girdhar Gyani, director general of AHPI told DH.
Under the Ayushman Bharat-NHPM, the health ministry would provide a family medical insurance of Rs 5 lakh to 10.74 crore poor families covering more than 50 crore individuals. As many as 1,354 procedures would be covered under the insurance.
Earlier AHPI had taken up the issue with Indu Bhushan, chief executive officer of Ayushman Bharat. “For Myocardial infarction (heart attack), the rate is simply not acceptable, whereas for club-foot it is exorbitantly high. It appears that overall, no scientific basis has been applied to arrive at the rates,” the association stated in its May 31 letter to Bhushan.
The opposition comes on the eve of states signing agreements with the health ministry to implement the ambitious scheme, dubbed as Modicare.