Capped subsidized rates will dilute quality and affect healthcare
Indian private Healthcare industry which serves 80 % of the population is passing through a turbulent period as a result of various populistic schemes like CGHS, ECHS and Ayushman Bharat which practice capped subsidized package rates and services majority of patients. Crores of rupees are due to be paid by CGHS/ ECHS/ Ayushman Bharat to private hospitals.
The outstanding is pending for past several months and no interest is being paid on such outstanding, which is already taking a toll on the day to day functioning of the hospitals. Hospitals are unable to even pay salaries to the employees. If this situation continues, it is feared that lakhs of hospital employees will lose their jobs. Vidarbha Hospital Employees Union has already raised cudgels against this anticipated problem. Many private hospital of the city are for sale because of non-viability said Dr Anoop Marar Director Orange City Hospital and Research Institute.
City based Hospitals having been pushed to the brink of unsustainability, have now been constrained to suspend cashless services for the beneficiaries of 3 insurance companies who have recently formed a cartel to similarly impose capped minimalistic all-inclusive package rates as done through government schemes for poor patients. Shortly, these hospitals will stop cashless service to CGHS beneficiaries also. Vidarbha Hospitals Association, a group of 160 private hospitals has questioned the logic of capping and reducing the rates when the hospital expenses continue to grow matching inflation. The hospitals are unable to sustain themselves. Such a hostile environment is not conducive to existence and viability of any hospital and will affect the healthcare sector.
The private patients uncovered by either CGHS/ECHS/Ayushman Bharat schemes are now insured with major health insurance companies namely United India Insurance, Oriental Insurance or National Insurance on payment of premium. Till date, these insurance companies were empaneling hospitals and reimbursing for the services utilized by their clients at the negotiated hospital rack rates. Of late, these 3 insurance agencies and their TPAs have got together and are dictating the reimbursement all-inclusive package rates, which is less than the present cost incurred by the hospitals in rendering the services. This endangers the quality of care and safety of the patients.
In view of these arm twisting tactics of the cartel; 45 Member hospitals of Vidarbha Hospitals Association have recently stopped cashless services to health insurance beneficiaries of these 3 major insurance companies serviced by 6 major TPAs of Nagpur.
This decision affects lacs of the health insurance beneficiaries. People pay health insurance premium so that in times of need, cashless health care is available. One does not have cash ready during hospitalization and it creates lot of problems if admission of self or any dependent is required. Health insurance is propagated only to avoid this.
National Insurance Company, United India Insurance Company and Oriental Insurance Company serviced by MD India Health Insurance TPA, Genins India Insurance TPA, Family Health Plan TPA, Paramount Health Services & Insurance TPA, Health Insurance TPA of India and Health India TPA Services have formed a sort of cartel to remove hospitals from empanelment list if they do not agree for a rate cutting to tune of 50-80% of ongoing agreed tariff.
Insurance Beneficiaries Association, an organization formed to protect the interests of insurance premium payers have queried to these companies that even when the premium amounts are increasing stating increasing costs how come hospitals are being forced to accept subsidized all-inclusive package costs? Such mandatory cost cutting will indirectly affect the health insurance beneficiaries as the consenting hospitals will be forced to dilute the quality of treatment which is detrimental, they have stated.
When any one pays a health insurance premium, the citizens are shown an elaborate list of hospitals. In such case, how can the insurance companies discreetly remove names of reputed hospitals without taking the insured into confidence? This is against contract. This is treachery against the health insurance beneficiaries.
If Insurance companies and TPAs insist on a very low package rates inclusive of diagnostics, medicines and consumables essential for treatment, who assures the health insurance beneficiaries that consenting hospitals will not be forced to deliver care and services in compromised settings?
Valuation of approved hospitals should be ideally done on basis of past service, feedback of beneficiaries, reputation, accreditations, quality, infrastructure and gradation rather than only the minimal rate offered.
Vidarbha Hospitals Association, Insurance Beneficiaries Association and Vidarbha Hospitals Employees Union have already sent across protest letters to government authorities against these deviating insurers. Last heard, the 3 associations are learnt to have consulted lawyers and are compiling data to fight legal battle against the health insurance cartel.
