Revised rates of Ayushman Bharat insufficient for private sector: IMA

A day ahead of a mega event to celebrate one year of Ayushman Bharat, IMA says it is a failure  

By DTE Staff
Last Updated: Sunday 29 September 2019
The IMA has said the government must rethink Ayushman Bharat. Photo: Getty Images

The Indian Medical Association (IMA) has said the rate revision of various packages offered under the Ayushman Bharat scheme by the Centre to increase the participation of private hospitals might not serve the purpose and it was not satisfied with the revised rates.

IMA said Ayushman Bharat was not viable for private hospitals while addressing a press conference a day before a mega event celebrating one year of the Modi government’s ambitious scheme on September 30, 2019.

Earlier this month, speaking at an event on Ayushman Bharat, Union Minister of Health and Family Welfare Harsh Vardhan had said, “The governing board of the National Health Authority has decided to overhaul the existing health benefits packages and rationalise the cost of the packages to remove any aberrations.”

This, he added, would ensure wider private sector participation by empanelling more hospitals to improve access to hospitalisation-related care.

The National Health Authority (NHA), the implementing agency of Ayushman Bharat, had announced that there would be an upward movement of over 270 packages under the scheme.

According to the major overhaul, the government introduced 239 new packages. In all, 1,395 packages are being provided under the scheme.

“The cost is much below the cut-off viability costs of many institutions. The recommendations of the costing committee that was formed by the government when this scheme was being conceptualised and of which IMA too was a member, were never implemented in spirit,” IMA secretary Asokan RV told Down To Earth.

“Instead, the 23 multi-speciality committees, which had doctors of various clinical disciplines whose mandate were originally to define the modality of specific surgical procedures, were asked to suggest prices over and above. They were doctors who knew about technicalities of the procurer and not the costing,” he added. 

The press release issued by the IMA said the government must rethink the entire scheme.

Instead of relying on an insurance-based model which had failed worldwide to deliver, it should have worked on the High-Level Expert Group (HLEG) committee recommendations which came out in 2011, Asokan said.

“The entire pretext of this scheme is that the government wants to engage with the private sector in healthcare. The HLEG also suggested ways and means to do that without the introduction of a third party known as insurance company. We are paying them a hefty fee of 15 per cent,” Asokan said. 

The HLEG was instituted by the erstwhile Planning Commission, which gave a report on providing universal healthcare coverage (UHC) to citizens, an aim that Ayushman Bharat too hopes to achieve. Its report is considered a landmark document on UHC in India.

However, the HLEG had criticised insurance-based health models and had said, "The HLEG's vision of UHC transcends the narrow, inadequate and often inequitable view of it as merely a system of health insurance. UHC moves beyond 'insurance' by providing assurance of healthcare, going beyond a mere illness response. UHC should ensure health in all of its dimensions which are ignored, neglected or even undermined by usual systems of health insurance.”

The IMA also questioned as to why insurance companies should be allowed to come in between government hospitals and the government.

“If the government wanted to fund the public hospitals, they should do so directly. In any case the government provides free treatment to patients in government hospitals. Why should it now be done through insurance companies by paying a 15 per cent fee to them,” the press release said.

The government has also blacklisted more than 90 hospitals across India who were empanelled under the scheme for various kinds of frauds.

The IMA alleges that this is a “negative approach of the government to name and shame the hospitals and has been borrowed from the ‘For Profit’ insurance companies and the dehumanised approach of the Insurance Regulatory Authority of India.” 

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