CGHS, Aarogyasri payments to hospitals not made on time
Extremely low rates of operating costs and procedures is making small, medium and corporate hospitals reluctant to join the flagship Ayushman Bharat health scheme of the Central government which will provide `5 lakh insurance coverage per family per year. The draft scheme has been discussed with the Indian Medical Association and Association of Healthcare Providers of India and found to be wanting in several areas.
President of the Indian Medical Association (IMA) in Telangana, Dr T. Narsinga Reddy, says that the scheme has been formulated on a cost to cost basis.
“They have not taken into consideration the operating, equipment, salary and maintenance costs in hospitals. They have merely taken the rates in government hospitals and accordingly formulated the costs for the procedures. We have now been called for a discussion as many of the small hospitals too are not willing to be a part of the scheme,” he said.
Ayushman Bharat requires the support of small and big hospitals. The model is based on the Central Government Health Scheme (CGHS) and Rajiv Gandhi Aarogyasri scheme. CGHS is the basis for reference for determining the cost of surgical procedures and Aarogyasri is for the online feasibility to run the project by providing immediate approvals. But to ensure that it is acceptable, the feasibility of costs has to be considered.
A senior member of the Telangana Super-speciality Hospitals Association said on condition of anonymity, “CGHS provides the cost of surgeries, but the costs have not been revised in the last three years. The government has taken rates which are lower than the existing rates by 20 to 25 per cent. Hence, the total reduction in the rates is 50 per cent and this has been been placed before us. This is not acceptable even to small hospitals; it will just not be possible to meet the costs.”
Director-general of the Association of Healthcare Providers of India, Girdhar J. Gyani, says that 2,500 super-speciality hospitals in the country have refused to participate in the Ayushman Bharat scheme because of the low reimbursement rates.
The hospitals include Apollo Hospitals, Fortis Healthcare, Narayana Health, and BLK Super Speciality Hospitals.
The biggest problem in formulating one price is that there is no standardisation Timely insurance reimbursement to stakeholders is very important for the success of government health schemes. But in both the Central Government Health Scheme (CGHS) and the Aarogyasri scheme, currently operational in states, payments by government to hospitals is not made on time. This is one of the major reasons that most healthcare providers do not want to be part of such government health schemes.
A senior healthcare of costs for diagnostics, consultations, surgical procedures and post-operative care across the country.
Dr K.K. Aggarwal, senior cardiologist and former president of the IMA explains, “We need to have standardisation and one price to facilitate such schemes. This will ensure transparency. Currently, there is too much of confusion as provider in a private hospital revealed that CGHS bills are kept pending for six months to a year and Aarogyasri backlog in Telangana is now more than eight months. “Payments are made only when there is a call for withdrawal of services or a strike. This has made many wary and they do not want to be part of any government insurance scheme.”
The present backlog in payment for Aarogyasri in Telangana is more than `200 crore and hospitals are demanding the reimbursement. This casual attitude there are varied prices for the procedures.”
Looking on the brighter side, R. Govind Hari, secretary of TSHA says the “budgetary allocation for this scheme is `1,200 crore and there are going to be 1.5 lakh health and wellness centres which will provide comprehensive healthcare for noncommunicable diseases and maternal and child healthcare services. This towards the present schemes and cutting of almost 50 per cent of the money has made the healthcare sector extremely wary of government schemes.
Says a senior member of the IMA in the city “There are 20 small hospitals on sale as they are not able to meet the healthcare costs. Earlier, when Aarogyasri payments were on time, many of them survived but that is not the case now. We were hopeful that the new central insurance scheme would help to revive the healthcare sector but that has not happened.” is an important part of the scheme as preventive healthcare is also being stressed upon and not only the treatment.”
The various stakeholders in the medical fraternity are giving their inputs as they want to tighten the loopholes before the launch on August 15 which is the tentative date if all stakeholders agree to the terms and conditions.