Hyderabad: Extremely low rates of operating costs and procedures is making small, medium and corporate hospitals reluctant to join the flagship Ayushman Bharat health scheme of the Central government which will provide Rs 5 lakh insurance coverage per family per year. The draft scheme has been discussed with the Indian Medical Association and Association of Healthcare Providers of India and found to be wanting in several areas.
President of the Indian Medical Association (IMA) in Telangana, Dr T. Narsinga Reddy, says that the scheme has been formulated on a cost to cost basis.
“They have not taken into consideration the operating, equipment, salary and maintenance costs in hospitals. They have merely taken the rates in government hospitals and accordingly formulated the costs for the procedures. We have now been called for a discussion as many of the small hospitals too are not willing to be a part of the scheme,” he said.
Ayushman Bharat requires the support of small and big hospitals. The model is based on the Central Government Health Scheme (CGHS) and Rajiv Gandhi Aarogyasri scheme. CGHS is the basis for reference for determining the cost of surgical procedures and Aarogyasri is for the online feasibility to run the project by providing immediate approvals. But to ensure that it is acceptable, the feasibility of costs has to be considered.
A senior member of the Telangana Super-speciality Hospitals Association said on condition of anonymity, “CGHS provides the cost of surgeries, but the costs have not been revised in the last three years. The government has taken rates which are lower than the existing rates by 20 to 25 per cent. Hence, the total reduction in the rates is 50 per cent and this has been been placed before us. This is not acceptable even to small hospitals; it will just not be possible to meet the costs.”
Director-general of the Association of Healthcare Providers of India, Girdhar J. Gyani, says that 2,500 super-speciality hospitals in the country have refused to participate in the Ayushman Bharat scheme because of the low reimbursement rates.
The hospitals include Apollo Hospitals, Fortis Healthcare, Narayana Health, and BLK Super Speciality Hospitals. The biggest problem in formulating one price is that there is no standardisation of costs for diagnostics, consultations, surgical procedures and post-operative care across the country.
Dr K.K. Aggarwal, senior cardiologist and former president of the IMA explains, “We need to have standardisation and one price to facilitate such schemes. This will ensure transparency. Currently, there is too much of confusion as there are varied prices for the procedures.”
Looking on the brighter side, R. Govind Hari, secretary of TSHA says the “budgetary allocation for this scheme is Rs 1,200 crore and there are going to be 1.5 lakh health and wellness centres which will provide comprehensive healthcare for non-communicable diseases and maternal and child healthcare services. This is an important part of the scheme as preventive healthcare is also being stressed upon and not only the treatment.”
The various stakeholders in the medical fraternity are giving their inputs as they want to tighten the loopholes before the launch on August 15 which is the tentative date if all stakeholders agree to the terms and conditions.
