India's private hospitals cry foul over excessively low Modicare rates

Some procedures are over 30% cheaper.

Private healthcare providers are protesting the excessively cheap rates set by India's Ayushman Bharat health insurace scheme.

Packages under the scheme popularly known as Modicare are cheaper that treatment packages under the current Central Government Health Scheme (CGHS). For instance, under the tender for Ayushman Bharat, the rate given for coronary artery bypass grafting (CABG) is Rs.90,000 whereas the rate under CGHS 2014 for Bangalore was at Rs.1,25,300 (non-NABH) and Rs.1,44,095 (NABH).

"Revision or non-acceptance of package rates by hospitals will also hamper rolling out of the scheme," CARE Ratings

Under the scheme, all public hospitals with inpatient facilities shall be deemed to be enrolled. Meanwhile, private healthcare providers (both for profit and not for profit) which provide hospitalization and are eligible for empanelment under Pradhan Mantri Rashtriya Swasthya Suraksha Mission (PMRSSM) would be considered.

The scheme covers 1,350 treatment packages which including cardiology, orthopaedics, urology, general surgery, burns management, neo-natal, paediatric cancer, oncology among others.

"Some private hospitals that represent Industry Bodies and Professional Association have requested to increase the package rates for hospitals under the scheme. The treatment packages for coronary bypass, knee replacements and stents among others are cheaper compared with packages under the CGHS.

"The private as well as public hospitals are expected to charge the same rates as mentioned in the treatment package though it is a known fact that the treatments in private hospitals are much more expensive compared with public hospitals. To offs t this or to provide some relief to the private players, the private hospitals may get up to 40% higher rates given they fulfil certain conditions," the report said.