New Delhi: The government has said in parliament that it will not revise rates of the Ayushman Bharat health insurance despite demands from the private sector to do so.
“At present, there is no proposal to review the prices of packages being offered under the AB-PMJAY,” said the government in the Lok Sabha.
They have also said that they don’t wish to change the rates because of the impact this can have on the market: “constant changes in package rates can lead to volatility in rates and may have unintended and undesirable consequences for the entire health sector.”
The news comes as a surprise to people like Dr Alexander Thomas from the Association of Healthcare Providers India (AHPI). He says that his organisation has been in talks with the government for many months on increasing the rates and they were told new rates will be released on July 31.
“The government has budgeted about Rs 7,000 crore only for the scheme, which is insufficient. It seems they are trying to force private hospitals to keep the costs low so that people can access services. But the prices are too low. The government’s intention is good but it comes at the cost of the private sector. Healthcare is after all the government’s duty,” said Thomas.
AHPI has been in talks with the government for over a year on increasing the rates of medical procedures, participating in a committee on cost and treatment guidelines. They say about 10,000 hospitals are part of their network. They were told the Central Government Health Scheme (CGHS) rates would be increased after the Ayushman Bharat ones.
Health activists disagree with this approach completely. “Price changes don’t really help patients because the scheme itself is more private sector friendly than patient centric. Investing money in prevention, health education and public health systems would be better use of the budget. Now unregulated private sectors can only hold the government to ransom without increasing accountability systems,” says Sylvia Karpagam, a public health doctor and researcher based in Bangalore.
In 2018, the government announced the Ayushman Bharat scheme in 2018 as the “world’s largest healthcare programme,” revealing later that it was a health insurance scheme which would cover 500 million Indians and exclude about 700 million.
The Wire has been reporting for over a year on the discontent of the private sector to participate in the scheme, as well as the discontent among health activists who caution against a private sector take over the government’s health delivery.
Now the government has said in parliament that they are not planning to revise rates which they have fixed for various medical procedures. This means that any hospital empaneled to participate in the Ayushman Bharat scheme and treating patients who are eligible for the scheme, can only claim the amounts fixed by the government, even if they find it low.
Currently the government has fixed the rates of 1,393 packages of medical procedures, everything from pregnancies to other surgeries.
The government has worked in a margin for states to increase or decrease the rates by 10% as per their discretion. These rates were decided by a committee headed by the director general of health services after consultations with various stakeholders including private hospitals and industry groups. The rates were reviewed by the NITI Aayog.
The Wire reported in June 2018 as well, that the government has frozen the rates and wasn’t keen to change them. “We will only be correcting errors, but not making any overall revisions. Any revision will have to be based on fact and logic. But no revisions are planned anymore,” said former government official, Dinesh Arora, to The Wire.
Bringing truth to the apprehensions expressed by many health activists in India, the government also announced a range of sops for private hospitals to participate in the scheme, such as subsidised land.
Cases of fraud have also begun to emerge in the scheme and a court case on this issue is currently underway in Uttarakhand.