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Top private hospitals may not participate in Modi govt’s flagship healthcare scheme

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Many super-speciality hospitals may not empanel for Ayushman Bharat, saying reimbursement rates are as low as 11-15 per cent of the actual costs of surgeries.

New Delhi: Around 2,000 super-speciality hospitals have decided not to be a part of the Modi government’s ambitious healthcare scheme Ayushman Bharat — touted as the world’s largest national health insurance scheme and popularly referred to as Modicare.

Reason: The government reimbursement rates are as low as 11-15 per cent of the actual costs of surgeries or procedures.

However, the government said it is voluntary for hospitals to participate in the scheme, expected to be launched by Prime Minister Narendra Modi on 15 August and that the decision of these hospitals won’t affect its implementation.

“Well-known hospitals across India, including Sir Ganga Ram Hospital, Medanta, Fortis Healthcare, Apollo Hospitals, Narayana Health and BLK Super Speciality Hospital have refused to participate due to the lower reimbursement rates,” said Girdhar J. Gyani, director general, Association of Healthcare Providers, India (AHPI), which represents 2,500 speciality and 8,000 smaller hospitals.

Super-speciality hospitals are those which are primarily engaged in the care and treatment of patients who require specific surgical procedures such as cardiovascular surgery, knee and hip replacement, liver transplant and angiography, among others.

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

No compulsion to join the initiative

“It is voluntary for hospitals to participate in the scheme,” said Indu Bhushan, chief executive officer at Ayushman Bharat.

“We have done the cost analysis and yes, the rates are low. But that is what the scheme is meant for,” the top official added.

Bhushan, however, said the government will reconsider the proposed rates after the launch of the policy in August.

If the 2,000 super-speciality hospitals are not empanelled for the scheme, patients can get the benefits of the scheme in around 8,000 government hospitals across the country. Also, more than 10,000 private hospitals have agreed to participate in Ayushman Bharat.

Why some hospitals are reluctant to participate

Under this health protection scheme, the proposed rates of over 1,350 surgeries and procedures are 15-20 per cent lower than Central Government Health Scheme (CGHS). The cost of therapies range anywhere between Rs 1,000 and Rs 1.5 lakh
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.

“We are concerned at the very low reimbursement rates that have been recently notified under this flagship programme,” Daljit Singh, president, Fortis Healthcare told ThePrint.

“Prima facie it appears that we will find it extremely challenging to provide quality services at these rates,” Singh added.

Naresh Trehan, chairman and managing director, Medanta, echoed the concerns. “The rates, which the government has offered, are not realistic. They haven’t calculated our overhead expenditures,” he said.

“We are ready to support that initiative but the scheme rates are just not doable,” Trehan added.

These hospitals are also unhappy at the delayed cycle of payments under the existing CGHS.

“Government takes six months to one year to pay our reimbursements for treatments under CGHS. We don’t want to get into another scheme unless government assures us that the payments are made within 15 days,” said a senior official at a leading Delhi hospital.

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