Hospital Hits Hurdle on Issue of Medical Procedure Rates

While the central government is sounding confident about the participation of all private hospitals in the ₹20,000-crore Ayushman Bharat-National Health Protection Mission (AB-NHPM) scheme, the empanelment of healthcare institutions is likely to be delayed as most multi-specialty facilities remain disappointed with the rates fixed by the health ministry for surgeries and procedures. An influential lobby group of healthcare providers, which has been making representations to Niti Ayog and Ayushman Bharat CEO, has received a negative response on their plea, it is learnt. The AB-NHPM scheme aims at providing up to ₹5 lakh health insurance cover for 10 crore below-poverty-line families identified using Socio-Economic Caste Census data and the government seeks to rope in more than 20,000 hospitals for its implementation. Though more states are getting ready to jump on the bandwagon, the mega project would be derailed unless the disagreement over hospital rates is resolved immediately, say industry sources.

The Association of Healthcare Providers of India (AHPI), a lobby group representing more than 3000 private healthcare institutions, in a letter to AB-NHPM CEO Indu Bhushan, had said that the rates fixed for surgeries and medical procedures were extremely low. The health ministry later revised the policy, under which hospitals in different states would be paid differently for various procedures. The rates for hospital procedures were also increased by 11-15 percent than what was proposed in the tender floated earlier. However, the rates, even after revision, are nowhere near the actual cost, according to the AHPI. “Private hospitals won’t be able to sustain themselves in providing quality health care unless the rates are scientifically fixed. They have banked on Central Government Health Scheme (CGHS) for fixing rates. There is no scientific basis to this rate fixing,” AHPI Director General Dr Girdhar J Gyani told.

The ministry has already launched a portal to allow states to empanel hospitals under the mission. According to a health ministry notification, the training of this empanelment software will be conducted in the coming weeks and states can begin empanelment of hospitals by July 1. However, in the present scenario, most super-specialty hospitals may stay away from the program as the participation is on a voluntary basis. “Even after getting listed, a hospital can reject a request for a medical procedure. Empanelment doesn’t mean a patient can utilize the facilities in a hospital whenever he or she need them,” an activist associated with a healthcare NGO pointed out. “The government has never discussed the details of the program with stakeholders like us. The program’s goals are indeed commendable and we also want to make it a success. But, in the present situation, it will face hurdles along the way. Unless they revise rates, the scheme will become ineffectual on the ground,” Gyani opined.

The AHPI’s position on the scheme acquires significance as, according to industry estimates, more than 12,000 100-bed hospitals are required to cater to the insured population. There are only 3000 government-run 100-bed hospitals, including medical colleges, district hospitals and health centers, where adequate infrastructure is available. “Officials concerned are working overtime to launch the scheme by August. But without private healthcare providers’ active backing, the numbers won’t add up and the initiative will remain on paper,” the NGO activist added. – PharmaBiz

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