NEW DELHI: The reimbursements offered under government health insurance schemes fall short of actual cost of medical procedures by huge margins, a joint study by IIM-Bangalore, the Karnataka government and the National Accreditation Board for Hospitals and Healthcare Providers (NABH) has found.
The study included 20 frequently carried out medical procedures in government and private hospitals of Karnataka and followed patients covered under schemes such as central government health scheme (CGHS), Vajpayee Arogya Shree (VAS) and Yeshasvini in 2015-16.
The study found that for carrying out breast removal in case of advanced stages of cancer, the hospitals, on an average, spend Rs 1,74,954 while the money released by the state covered only 33.4 and 66.7 per cent of the cost under VAS and Yeshasvini schemes, respectively.
The reimbursement offered under CGHS for the same procedure is about 80 per cent in case of NABH accredited hospitals.
Similarly, for heart bypass surgery, the average cost of the procedure stood at Rs 1,88, 231 for hospitals while no scheme offered more than 68.9 per cent reimbursement.
“This was a first of its kind analysis using scientific methods with the help of scientists of health department of ISRO and other agencies,” said an analyst. The findings have given private hospitals a chance to defend the profit margins made by them. “Private hospitals are providing treatment at highly subsidised rates for most scheme patients as reimbursements are far lower than the actual cost,” said Girdhar Gyani, director general, Association of Private Healthcare Providers of India.He said the government “must engage in scientific costing of medical procedures” to correctly evaluate the actual cost incurred”.
The association demanded that the Centre should carry out a similar study for over 600 medical procedures across all states.