Biggest Private Hospitals Unlikely To Join Rs 5 Lakh Health Insurance Scheme
Around 1,200 of the biggest private hospitals across the country are unlikely to join the government’s flagship Rs 5 lakh health insurance scheme (Ayushman Bharat) for 40 crore Indians as they feel that the rates fixed for most surgeries and procedures are too low.
The Union Ministry of Health and Family Welfare, had proposed rates of over 1,350 surgeries and procedures under the Pradhan Mantri Swasthya Suraksha Mission (PMSSY), meant to provide insurance coverage to around 10 crore families in the country, the biggest such scheme in the world.
Officials in the ministry confirmed that the rates of reimbursements proposed under the programme are even lower, up to 20 percent than those in the Central Government Health Scheme, as this is a “massive” welfare scheme and hospitals were expected to “support”.
In a meeting with top government functionaries, an association of India’s biggest corporate hospitals made it clear that it won’t be sustainable for them to get empanelled for the scheme at the proposed rates.
We have told the government that the biggest super-speciality hospitals are unlikely to get empanelled for the programme, at least in the launch year, as the rates are as low as 11-15 percent of the actual costs in some cases, said director general, Association of Private Healthcare Providers of India, which represents 2,500 speciality and 8,000 smaller hospitals.
The fact is that rates under CGHS meant for Central government employees, pensioners and their kin are very low and have been fixed arbitrarily without any scientific basis, he said. So we want the government to open a cost analysis cell and do a comprehensive study of the actual cost of surgeries and medical procedures for fixing rates.
The association also handed over a first-of-its-kind analysis jointly done by the Karnataka government and IIM, Bengaluru last year, which showed how the reimbursement offered under the CGHS and other health insurance schemes by states was way lower than actual costs.
A treatment for a brain aneurysm, aneurysm clipping, for instance, costs over Rs 3.5 lakh in a speciality private hospital but the government is offering just Rs 42,000 for the same.
We have, therefore, proposed to the government that hospitals be allowed to be empanelled for selective procedures for which rates are reasonable and opt out for the rest. But if that does not happen only smaller private hospitals will respond to the government’s call, he said.
A senior executive with a corporate hospital said that if small nursing homes got associated with the project, quality and safety would get compromised. A senior health ministry official said that the government was hoping to rope in about 20,000 hospitals for the scheme, which is likely to be rolled out on August 15.
We are looking at government and private medical colleges, district-level hospitals and speciality hospitals to get empanelled, but if that does happen in the launch year, we will review the reimbursements, he said.
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