BENGALURU: A week ahead of the state government signing an MoU with the Centre to implement Ayushman Bharat-National Health Protection Scheme (AB-NHPS), private hospitals are trying to get costs for various hospital procedures hiked, while labelling a study conducted by them as ‘Karnataka government costing study’. The state health secretary has, however, denied it being a ‘government-sponsored one’.
Association of Healthcare Providers India (AHPI), a private hospitals’ lobby group in Karnataka with a network of 3,000 private hospitals, has written to AB-NHPS CEO Indu Bhushan that “even the revised rates do not come anywhere close to the actual cost incurred by the hospitals, as per the costing study of the government of Karnataka...The participation of healthcare providers would be sparse and AB-NHPS will remain grossly ineffective on ground.”
The ‘study’ being cited by the AHPI is one chapter of the ‘Karnataka Public Health Policy’ that was published last year by the Karnataka Knowledge Commission or Karnataka Jnana Aayoga (KJA).AHPI president Dr Alexander Thomas chaired the procedural costing sub-committee. Though the methodology of the study was to analyse the cost for 20 procedures from private, government and the not-for-profit sector, the results are only of four private hospitals, all located in Bengaluru. Dr Devi Shetty, chairman and executive director, Narayana Health chain of hospitals, who was the chairperson of several sub-committees on KJA, and is leading the private hospitals in the state for demanding higher prices, refused to comment.
“Studying a few bigger hospitals by KJA in Bangalore does not make it representative costing,” Ajay Seth, Additional Chief Secretary, Department of Health and Family Welfare, said. “When we are talking about rates under a government scheme it is a much more structured process and there should be adequate representation from both government and private hospitals. The study that was done by KJA was done to provide inputs to a policy, it wasn’t a government-sponsored study,” he added.
Indu Bhushan, AB-NHPS CEO, said, “The methodology of the study that AHPI is referring to is questionable. We cannot go by a study that does not have a scientific basis. The study was never approved by the Karnataka government. Next week, we are hoping to sign the MoU with the Karnataka government.” He said the state government was given flexibility to change rates based on local context and cost structure.
“They can hike rates by 10 per cent anyway. All hospitals that are certified by NABH can increase the rates by 10-15 per cent, and teaching hospitals can also get 10 per cent hike. Some of our rates are higher than Central Government Health Scheme (CGHS), some are lower.”
Denny John, Evidence Synthesis Specialist, Campbell Collaboration, said, “First, there should be a reasonable sample size. Only four hospitals were selected. Ideally, it should have been random selection. Second, this was purposeful sampling. Bengaluru cannot be representative of the entire country. First, they are pushing these costs for a state-wide policy and then for a nation-wide AB-NHPS. Plus, people who are driving these hospitals have themselves selected these hospitals, so there is a conflict of interest there.”
Prof S Raghunath, IIM-B representative on the KJA costing committee said, “It will be unfair to call it an IIM-B study. There were a lot of other associations involved. Along with me, two of my chartered accountant students were also involved who did a huge amount of work in data analysis.”