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As Modicare Deadline Nears, Government Struggles to Get Private Hospitals on Board

Even as the Ayushman Bharat-National Health Protection Mission, commonly referred to as Modicare, is nearing its August 15 launch deadline, the government is struggling to convince private hospitals to participate in the scheme. Sources said that some healthcare providers are unhappy with the pricing of the scheme. On an average, the rates proposed under the AB-NHPM are almost 30-45 percent lower than what a hospital would normally charge. Apart from charging the patient for a medical procedure, hospitals also levy charges for equipment used in surgery, as well as for the manpower used for the purpose.

A top executive of a leading hospital chain said that the package rates announced by the government are financially nonviable given the overheads involved, so big hospitals may not evince interest in joining the scheme. The executive said that the private hospitals are seeking a revision in the package rates announced by the government. “We hope there could be some changes to the packages rates in the coming days,” he said. Even in the initial stages, the government will have to partner with at least 2000-3000 hospitals, considering the number of targeted beneficiaries of the scheme. But only a handful of private hospitals have come on board and the rest are all government-run hospitals.

The scheme

NHPM will be completely free for the beneficiary families and the premium for the policies will be shared between center and state in a 60:40 ratio. The scheme will cover as many as 100 million poor families. Once implemented, it will be the country’s largest health insurance program in terms of the size of insurance as well as the number of people covered. The government may make some partial changes in rates over the next few days in order to make the scheme more attractive to hospitals. “The rates that have been mentioned in the tender document are too low. For instance, an open-heart surgery would cost between ₹3.5 lakh to ₹4 lakh on an average, while the model tender document has capped it at ₹90,000,” said a senior industry official.

Though the government has tied-up with state-owned hospitals, the larger private sector hospitals are still in discussions with officials over the package rates. The model tender document released in May 2018 has capped the rates for medical procedures covered under the scheme. A detailed rate list has been put out for all surgeries, major and minor. This means that any hospital partnering with the government for the scheme will have to ensure that the rates they charge will have to be less than or equal to the stipulated amount. The government is keen on bringing large hospitals on board to ensure that the AB-NHPM succeeds on a larger scale. Not only do a majority of these hospitals have better facilities for complex procedures, they also have senior doctors who are specialists in their field working with them. – Money Control