Private players request review of Government Insurance Scheme
“If we need quality care, we need to spend money,” said Sunita Reddy, CEO of Apollo Hospitals. Reddy said though the scheme provides opportunity for the hospital’s tier-2 operations, the government needs to relook at the prices so patients do not end up getting substandard care. India’s 5 largest private hospitals have asked the government to reconsider the pricing list of the Ayushman Bharat Scheme, a flagship insurance programme of the Modi Government, because quality care to patients at current rates is unviable. The hospitals suggest that the government should have taken their inputs before deciding the package costs as announced by Niti Ayog, earlier this year. It is expected that the scheme would give insurance cover to a vast majority of Indians. A detailed list of 1,354 packages for 23 treatments covering various therapies and procedures was announced by Niti Ayog, expecting to provide insurance cover of Rs 5 lakh per family for up to 10 crore Indians below the poverty line. The policy covers hospitalisation, treatment expenses including for secondary and tertiary level of medical and surgical care. Depending on the complexity of the ailment, the procedure costs would be in the range of Rs 1,000 to Rs 1 lakh. Habib Khorakiwala of Wockhardt Hospitals mentioned about being unsure whether large hospitals would participate in this scheme. “The issue is not the total cover of Rs 5 lakh, it is the individual price point will not be possible to meet”, said Khorakiwala. “Some of the procedures are definitely unviable, we are anyways not looking for government schemes to give us money, but the pricing is definitely low,” said Dr Devi Shetty, adding that he expects a revision. As per the scheme, the cost of pulmonary artery double stenting is capped at Rs 65,000, a bypass surgery with synthetic graft at Rs 90,000, a cementless hip replacement at Rs 90,000 and knee replacement at Rs 80,000. The package rates are nearly 20% less than the treatment package covered under the Central Government Insurance schemes and state schemes like Rajiv Gandhi Bima Yojana. Kaustav Ganguli, managing director, of healthcare consultancy Alvarez and Marsel mentioned that most of the private players treat scheme patients on the back of a cost delivery model in areas like consumables, drugs, low staff cost and implants procurements. “When you expand the overall coverage per annum for a family and that too from Rs 30,000 to Rs 5 lakh per annum,” Ganguli explains, “the natural expectation would be that you will get realistic rates for the services provided”.
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