Govt looks to tempt pvt hospitals with revised rates

Five months after the Centre launched its flagship healthcare scheme Ayushman Bharat, the government is ready to revise the treatment package rates with the aim of roping more private hospitals into the mega health insurance programme.

Low package rates was cited as one of the key concerns of the private healthcare industry for not coming on board the world’s largest public funded medical insurance scheme.

Out of nearly 15,000 private hospitals, about 50% are now part of the scheme. But big names have given it a miss.

“We seek more participation of the private hospitals in the secondary and tertiary care as they cater to 70% of India’s health needs. They have concerns on the rates, which we are reviewing along with the Department of Health Research,” said Indu Bhusan, chief executive officer of the National Health Authority, the implementing agency for the scheme.

A major section of private hospitals opposed the Ayushman Bharat (Pradhan Mantri Jan Arogya Yojana) treatment rates, arguing that government rates were too low to recover the procedure cost they incurred in treating the patients. In many cases, the proposed cost is lower than the central government health scheme rates that was last fixed in 2014.

“Rigorous studies are required to justify the rate, which is not the case at the moment,” Bhusan told DH in an interview.

In the last 150 days, nearly 13 lakh people have benefited from the scheme. The government distributed 1.9 crore PM-JAY cards to the targeted families and the National Health Authority committed a payment of Rs 1,700 crore, out of which Rs 1,200 crore was paid. The amount of payment due beyond 15 days is only Rs 98 crore.

Bhusan said the allocation of Rs 6,400 crore in the interim budget was adequate for the scheme in the absence of four states — Delhi, Odisha, Telangana and West Bengal.

While the first three didn’t join the programme, West Bengal came out of the scheme, arguing that the programme was misused by Prime Minister Narendra Modi for political gains.

Nearly 40% of the reimbursement was on heart diseases (23%) and heart surgeries (16%) followed by orthopaedics (7%), urology (6%) and neurosurgery (4%).

The National Health Authority officials also want to integrate the PM-JAY component of the healthcare scheme with the other portion of Ayushman Bharat – the 1.5 lakh health and wellness centres, which the Health Ministry plans to set up to take care of the primary health care needs of the population.

“There should be an integration in such a way that the health and wellness centres should refer the patients to hospitals under Ayushman Bharat for treatment, and the patients, after being discharged from the hospitals, can go back to such centres for follow up and medication,” he said.