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Ayushman Bharat - Hospitals' Concern

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July 15, 2018

What is the issue?

Hospitals are displeased with the provisions of the Ayushman Bharat programme. Click here to know more on the scheme

What are the concerns?

  • Rates - Government recently published the rates that insurance companies would pay hospitals.
  • This applies for the 1,350 procedures covered under the scheme.
  • Hospitals have criticised these rates as being arbitrary and low.
  • E.g. the price of Caesarean section for 5 days of hospital stay, food and consultation is Rs.9,000
  • Even government hospitals incur Rs.7,000 a day just to maintain a bed.
  • Rationale - The reimbursement rates were not calculated in a scientific manner.
  • Doctors are thus concerned about the clustering of medical conditions in the rate list.
  • E.g. treatment for tuberculosis and HIV with complications will be reimbursed at the same rate of Rs.2,000 a day
  • Clearly, the degree of treatments for HIV and tuberculosis differ.
  • HIV complications can be relatively serious and these illnesses must be compensated differently in the scheme.
  • Hospitals - Ayushman Bharat relied on a study of over 100 hospitals in 60 cities.
  • But these were mostly hospitals with under 50 beds in tier-2 and tier-3 cities.
  • The cost structure of these hospitals is substantially different from tertiary-care hospitals in tier-1 cities.
  • But Ayushman Bharat rates do not account for these differences.

What is the government stand?

  • For now, the government is committed to the launch date of August 15.
  • But officials have acknowledged that the rates will be revised.
  • AHPI (Association for Healthcare Providers India) has been asked to submit a list of 100 key procedures.
  • Ayushman Bharat would then conduct a detailed cost study for this.
  • Until then, hospitals are asked to continue with the present rates.

 

Source: The Hindu

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