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Private hospitals agree to join Ayushman Bharat after Modi govt promises to revise rates

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Hospitals, however, have a caveat — say they will conduct only select procedures. Ayushman Bharat CEO says no such agreement has been arrived at.

New Delhi: Private hospitals and doctors have finally decided to join the Narendra Modi government’s ambitious healthcare scheme, the Ayushman Bharat, but with a caveat. The hospitals say they will accept the Centre’s rates for medical procedures but only on a select few.

The decision is a boost for the government that has been racing against time to ensure the success of its scheme ahead of the 2019 general elections. The initiative, touted as the world’s largest national health insurance scheme, is to be launched by Prime Minister Narendra Modi, most likely on 15 August, Independence Day.

The flagship scheme assures health insurance cover of up to Rs 5 lakh per family every year to 50 crore poor and vulnerable people.

“We have decided to join Ayushman Bharat after a meeting with senior officials Thursday. They have reassured us that they will revise the procedure rates within a year of the launch,” Girdhar J. Gyani, director general, Association of Healthcare Providers, India (AHPI), which represents 2,500 speciality and 8,000 smaller hospitals, told ThePrint. “We will, however, not accept patients for procedures whose costs are much lower in the scheme. We have conveyed this to the government.”

The Indian Medical Association, which had also been opposed to the rates under the scheme, too has agreed to join the scheme conditionally.

“As the government has decided to revise the procedure rates, IMA will be part of the consultation committee for revision of prices. We will pull out if the government fails to bring in the promised changes,” said R.N. Tandon, secretary general, IMA.

Indu Bhushan, CEO of Ayushman Bharat, confirmed the developments but denied accepting the hospitals’ caveat.

“I have agreed to work with them (hospitals) in the review of the rates. Change in the rates will require a process and we have started it. We have not reached an agreement on select procedures,” he said.

The government has been working overtime to ensure that the scheme is launched successfully. Just last month, it bowed to another demand by the hospitals — over the mode of payment. The government announced that it would fine insurance companies that delay payments and also took away their power to reject claims.

Why were hospitals reluctant?

In May this year, more than 2,000 super-speciality hospitals, including Sir Ganga Ram Hospital, Medanta, Fortis Healthcare, Apollo Hospitals, Narayana Health and BLK Super Speciality Hospital, refused to participate in the scheme because of the lower reimbursement rates.

The hospitals cited poor reimbursement rates and pending dues of over Rs 800 crore under an already existing insurance-based government healthcare scheme — the Central Government Health Scheme (CGHS).

Under Ayushman Bharat, the proposed rates for 1,350 surgeries and procedures are 15-20 per cent lower than CGHS. For instance, an aortic arch replacement under cardio-thoracic surgery would cost around Rs 15 lakh in a tertiary care hospital, which the government, under Ayushman Bharat, is offering for Rs 1.5 lakh.

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