Package rates in Ayushman Bharat scheme will put patient safety at risk, says IMA
The Indian Medical Association (IMA) on Sunday rejected 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% 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 50,000.
In an emergency meeting in New Delhi on Sunday evening, the IMA said the package rates were “unacceptable” but appreciated the government’s decision to empanel the hospitals from 10 beds onwards.
“These package rates are unacceptable as they are exposing the patients to danger in hospitals, as such low rates will have to be compromised with the quality of services being provided and will only breed corruption. This will have deleterious effect on patient safety. According to certain reports, IMA has fully backed this scheme, which is not true, but our objections about package rates, fund allocation and insurance model stand unchanged. IMA had also raised the need for scientific costing before fixing the rates. The cardinal objections raised by IMA remain to be addressed.” said Dr Ravi Wankhedkar, national president of IMA.
He, however, said the IMA was willing to partner with the government in the National Health Protection Mission provided “the package rates are revised to a reasonable level.”
In the meeting, objections were also raised against the insurance model of implementing the Ayushman Bharat - Pradhan Mantri Rashtriya Swasthya Suraksha Mission,with the IMA demanding an exclusive trust model.
Even at a marginal profit of 15%, crores of rupees would unnecessarily go to the third party. Therefore, in order to keep the current healthcare delivery system intact, and preventing it from collapsing, all the stakeholders including private players and IMA needs to be taken in confidence, Dr Wankhedkar said.
The Mission in its present form will also lead to elimination of small and medium hospitals, he added.
On May 24, Union minister of state for health Ashwini Kumar Choubey said the rates for over 20 specialties, including orthopaedics, cardiology, cancer care and neurosurgery were included in the packages under the scheme which aims to provide a coverage of Rs 5 lakh per family annually and benefit more than 10 crore families belonging to the poor and vulnerable sections of the society.
The government was also planning to incentivise private hospitals under the scheme to ensure that more quality hospitals come up in aspirational districts.
Hospitals certified by the NABH for entry-level would get 10 per cent more as incentive and those certified for advanced level would get 15 per cent. Hospitals offering MD and DNB would also get 10 per cent more. Hospitals set up in as backward and rural districts would get an additional 10 per cent.
The centrally-sponsored scheme would target poor, deprived rural families and identified occupational category of urban workers’ families, 8.03 crore in rural and 2.33 crore in urban areas, as per the latest SECC data, and will cover around 50 crore people.
According to a senior government official, the scheme would likely be launched by Prime Minister Narendra Modi on August 15.
To control the cost factor, payment for treatment would be done on package rate basis and it will be cashless transaction for the beneficiaries.