The IMA today demanded that the government renegotiate reasonable and fair package rates for its flagship National Health Protection Scheme (NHPS), which aims to provide a coverage of Rs 5 lakh per family annually and benefit more than 10 crore poor families.
The package rates fixed by the government are very low and at such low rates, it is "impractical" to provide quality services, the Indian Medical Association (IMA) has said.
"Curiously the government have fixed these costs arbitrarily without any scientific costing. Moreover they also talk about volumes, which will only benefit the insurance companies and the corporate hospitals, as small and medium hospitals do not have the ability to absorb such volumes," said Dr Ravi Wankhedkar, the IMA national president.
In recently held parleys, the IMA also declared its willingness to work with the government for the success of the programme.
Over 60 per cent of the own account enterprises (OAE) and establishments are run by modern medicine doctors and thus the IMA has the last mile connectivity which is essential for the success of the scheme.
Two of the three major demands of the IMA, including empanelment criteria and payment modalities, have been partially addressed. Empanelment, package rates, and claim settlement as well as grievance redressal are still the major areas of concern.
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The government has agreed to allow empanelment of all registered hospitals above 10 beds and have also promised a robust claim settlement mechanism and settlements within 15 days, said Dr R N Tandon, secretary general of IMA.
The scheme, Ayushman Bharat, targets the economically weaker sections, especially in tier III and IV towns. The IMA has genuine apprehensions that this well-intentioned initiative of the government will actually end up eliminating small and medium hospitals.
IMA has been working on the cost of procedures done commonly which is certainly an eye-opener. The government cannot wish away the realities as it will be unfair to ask the hospitals to provide services below their survival cost. IMA remains hopeful that the Prime Minister would address the situation himself," added Dr Wankhedkar.
Last week, the IMA had said that the package rates were unacceptable.
The Centre's recently announced packages in its ambitious National Health Protection Mission under which treatment for coronary bypass, knee replacements and stents among others would be provided at 15-20 per cent cheaper rates than the Central Government Health Scheme (CGHS).
Under the 205-page draft model tender document which was shared with the states last month, knee and hip replacements were fixed at Rs 9,000 each, stenting at Rs 40,000, coronary artery bypass grafting (CABG) at Rs 1.10 lakh, caesarian delivery at Rs 9,000, vertebral angioplasty with single stent at Rs 50,000 and hysterectomy for cancer at Rs 50,000.