BENGALURU:Aimed at providing secondary and tertiary level hospitalisation coverage to 50 crore Indians, the National Health Protection Scheme (NHPS) is expected to be rolled out on August 15 this year pan-India.
A meeting of NITI Aayog members with more than 30 private hospital management owners and healthcare association representatives at Confederation of Indian Industries here saw corporate hospital bigwigs from Narayana Health, Apollo, Manipal, and Fortis among others expressing disappointment with the cost of procedures fixed by the government. A 205-page draft tender document is available on NHPS website that covers rates for 20 specialties. 610 packages out of 1,355 packages require pre-authorisation by the insurance company.
NITI Aayog maintained it had not received any break-up of costs desired by private hospital managements for various procedures and hence it was only relying on existing data from state health insurance schemes, central government health schemes like CGHS, Rashtriya Swasthya Bima Yojana (RSBY) and insurance companies’ data for costing exercises.
It maintained that a profit of 10% to 15% was reasonable for hospitals to ask but that it has to come out in the open and write to the planning body on the costs it expects. The NHPS is expected to roll out in the country on August 15 or October 2 with a coverage of `5 lakh per family of five and will be co-branded in Karnataka with Arogya Karnataka with no overlap of beneficiaries.
Dr Devi Shetty, founder, Narayana Health, said, “Karnataka pioneered micro health insurance schemes. Private hospitals started Yeshaswini scheme on a pilot basis and then went to the government, it wasn’t the other way round. We are struggling in the last few years with government policies. Our policy-makers are pushing towards a first-world regulatory structure with a third-world infrastructure.” “We never look at government schemes to earn a lot of money but we are looking at viability. Minimum wages and electricity tariff have gone up. We have more BPL cards than people. Costing is the root cause of all problems,” he added.
Vinod Paul, member of NITI Aayog, said, “The government has proposed rates for 1,355 packages. The state governments can increase or decrease the costs by 10 per cent if they feel the need to. Rates were devised scientifically after we looked at various packages of state governments, CGHS, RSBY and insurance companies’ data of IRDA and Gibson.”
“Private hospitals demand for a profit margin of 10 to 15 per cent which is fair enough but they don’t share break-up of costs if they have a problem with a C-Section cost or a cataract cost. I haven’t seen a single break-up of prices expected by private hospitals who have justified it based on consumables required or whatever equipment is required for the procedure,” he said.
Govindaiah Yatheesh, Assistant Medical Director, Apollo Hospitals Group, Karnataka region, said, that their balance sheets are out in the open and the government can analyse that to figure out costs to which Paul retorted that balance sheets do not give an indication of what a cataract procedure, for example, costs in the hospital.