Lack of interest for the insurance scheme from Delhi hospitals, which are citing low rates, could dent the Modi govt’s flagship scheme.
New Delhi: Just three private hospitals in Delhi have enrolled for the Modi government’s flagship health insurance scheme — Ayushman Bharat — with the Prime Minister’s Office (PMO) now worried about the poor empanelment rate in the national capital, ThePrint has learnt.
Of the 900 private hospitals in Delhi, the National Health Agency (NHA) — an arm of the Health Ministry implementing the scheme — has got on board just the Cygnus Sonia Hospital in Nangloi, Dr. Shroff’s Charity Eye Hospital and the Cygnus MLS Super Speciality Hospital.
The sticking issue continues to remain the same, with the hospitals arguing that reimbursement rates are as low as 11-15 per cent of the actual costs of surgeries or procedures.
But with just months left for the 2019 general elections, the Modi government is racing against time to empanel more hospitals to the initiative dubbed the world’s largest health insurance scheme.
“There is a lot of pressure from the PMO on the team of Ayushman Bharat to enrol Delhi’s private hospitals. It has been a discussion point in almost all the meetings,” said a senior NHA official negotiating with the hospitals. “This could be a setback to otherwise such a laudable and noble scheme.”
The government made some headway, recently announcing a tie-up with Medanta, a super specialty hospital run by Dr Naresh Trehan in Delhi-NCR, but the hospital is still not officially on board and is likely to tie up for only selective procedures, mostly related to heart health.
“We are still working out on the details of our association with the scheme. We are trying to cover as many areas as we can,” Dr Trehan told ThePrint through the phone.
Indu Bhushan, CEO, Ayushman Bharat, said many hospitals are showing interest in the scheme.
“Hospitals, in general, want the rates to be revised upwards. This is not surprising. Many hospitals, however, are prepared to work on these rates,” Bhushan said. He denied that there was pressure from the PMO.
Bhushan further said that apart from the three hospitals, three more — Lifeline Hospital, Dwarka; Kalra Hospital in Kirti Nagar and the Centre for Sight, Safdarjung Enclave — are in the process of being empanelled.
Four other hospitals have also given a positive response, Bhushan said.
Why Delhi is important
As the country’s capital, Delhi receives as much as 40 per cent of its patients from the other states. According to Association of Healthcare Providers, India (AHPI), which represents 2,500 specialty and 8,000 smaller hospitals in the country, Delhi is expected to contribute to the scheme 10,000 state government hospital beds, 5,000 beds of central government hospitals and 35,000 from the private sector.
The Aam Aadmi Party government, however, has refused to be part of the health insurance programme following which the NHA in November invited private hospitals to get empanelled with the scheme.
Rates the sticking point
The hospitals in Delhi continue to point to the rates offered for the procedures for their lukewarm response.
“The rates fixed in the scheme are completely irrational. They were fixed without doing any scientific study,” said Girdhar J. Gyani, director general, AHPI. “The government has to urgently review the rates without which hospitals in general and those in the tertiary care, in particular, will not be able to join.”
He added that the scheme may have gained acceptance in the national capital if the Delhi government had agreed to be a part of it.
“States that were running their own schemes, which will now be merged with Ayushman Bharat (except in Telangana), have been allowed to retain their (state scheme) rates,” Girdhar said. “These rates are much higher than those in Ayushman Bharat. This is the reason that hospitals in these states will still be able to take these patients.”
For instance, according to AHPI, the rate for Balloon Atrial Septostomy, a cardiology procedure, is Rs 18,000 under Ayushman Bharat. For the same procedure, the Maharashtra government pays Rs 30,000; Telangana reimburses Rs 33,380 while hospitals in Karnataka get Rs 25,000.
The hospitals in Delhi have advised NHA to pick up the rates that are the maximum and make them uniform across the country.