In the absence of cost-based pricing for treatment of various conditions under Ayushman Bharat — the Centre’s health insurance scheme — Niti Aayog will soon start cost-based scientific studies taking everything into account including profit margin, said Niti Aayog member Vinod K. Paul here on Monday. Addressing representatives of private hospitals at an interaction organised by the Confederation of Indian Industry (CII) here, Dr Paul said meetings have been held with the Department of Health Research. “We have set up a group and are looking at working out standard treatment guidelines and scientific costing for at least 100 priority conditions, including in tier 2 and 3 cities. In a year’s time we should have something which is more scientific,” he said. Ayushman Bharat, the ambitious health insurance scheme of the Modi government that is set to be rolled out in alliance with State governments soon, aims to provide an annual health cover of ₹5 lakh to 10.74 crore families.
Under the preventive health component of Ayushman Bharat, 153,000 health and wellness centers will be set up across the country. Beneficiaries for the scheme will be identified on the basis of deprivation and occupational criteria as per Socio Economic and Caste Census 2011 data, he said. Earlier, representatives of private hospitals raised concerns about low pricing of various procedures and demanded proper identification of beneficiaries, fair price, and prompt payments by the government for patients treated under the scheme. Dr Paul, who asked the members to provide actual cost-based break up of procedures, assured them that scientific pricing would be done in future. “Till then, the scheme will continue at the existing stipulated prices. We seek your cooperation in running the scheme,” he said.
Devi Shetty, Chairman of Narayana Health and SC Nagendra Swamy, principal coordinator of the Federation of Healthcare Associations, Karnataka said private hospitals were willing to participate in the scheme. “However, we are worried about low prices and pending payments of ESI and Central Government Health Scheme (CGHS) patients in the past,” Dr Swamy said. To that, Dr Paul said the bad experience with the CGHS would not be repeated. Meanwhile, the private hospitals heads have left the choice of empanelment to the discretion of individual hospitals. “If they find the rates viable, especially in tier 2 and 3 cities, they can opt for it,” a source said, adding that cost-based studies will be shared with Niti Ayog soon. – The Hindu