Even as the Centre is preparing ground for the world's largest health insurance scheme, an influential section of doctors is unhappy with certain aspects of the scheme. The Indian Medical Association (IMA) has “rejected” the package rates for several procedures, as decided by the health ministry and published in a model tender document.
"These rates are not sustainable when it comes to small nursing homes and hospitals. Such low rates will only ensure that these establishments end up shutting shop," Dr R.N. Tandon, secretary general, IMA, told THE WEEK. Tandon said that while the health ministry had agreed to accept the IMA's suggestion of empanelling the hospitals with ten or more beds, the money it was offering for common procedures such as gall bladder stone surgery were certainly not "acceptable".
"For instance, the rate that has been approved for a cesarean delivery is Rs 9,000. That is way too less," Tandon said, adding that the IMA had shared its view on the rates with the CEO of the Ayushman Bharat scheme, Dr Indu Bhushan as well. However, when asked about what the ideal rates for such procedures should be, Tandon was evasive on the subject and said that the ministry was aware of the rates that the IMA approved of, and the association was willing to work with government on the subject.
Tandon also said that the IMA was not much concerned about the interests of big corporate hospitals in metro cities – those would make profits because of the volume of procedures that they would be able to do under the Ayushman Bharat scheme. “They can add more beds to do more procedures. But what about a small nursing home, which has, say, only 12 beds? That place can't add any more beds. So, the numbers argument that the Centre is giving doesn't make any sense,” said Tandon.
“We are for protecting the interest of the smaller establishment, especially those that are out of the metro cities, in the periphery, where bulk of the patients are going. It is for those places that the rates should be revised,” he added.
Interestingly, on June 22, in a statement released to the media, Tandon had said that the IMA was “proud” to be associated with Ayushman Bharat-National Health Protection Scheme (AB-NHPM) and would be “keen” to “provide help in spreading awareness and developing a larger network of quality service providers especially in Tier 2 & Tier 3 cities.”
The statement came after a meeting between Bhushan and Tandon where they discussed “potential collaboration” in implementing the scheme. IMA representatives agreed to extend their support for better implementation, especially in the field of “empanelment of hospitals, spreading awareness and beneficiary identification processes”.
However, on Sunday, the IMA sent out a statement saying that it held an “emergency” meeting where it was decided that the current package rates were unacceptable. “The goverment is exposing patients to danger in hospitals. Such low rates will compromise quality and breed corruption. This will have a deleterious effect on patient safety,” the IMA statement read. The statement further clarified that some media reports which suggested that the IMA was fully backing the Centre on the scheme, was untrue. “IMA's objections about package rates, fund allocation, and insurance model stand unchanged. IMA had also raised the need for scientific costing before fixing the rates,” it said. The statement also said that the IMA favoured the trust model, as opposed to the insurance model.