SC asks Centre to fix hospital treatment charges for entire country

The general insurance industry, where the health portfolio almost contributes around Rs 1 lakh crore of premium, is now keenly watching the development and expect a positive outcome on the hospital charges. The industry, which recently launched its scheme ‘Cashless Everywhere’, where a policyholder can receive treatments from any hospital in the country and not just from its own insurer’s empanelled hospitals, is facing issues as hospitals across the country are not adopting standardised rates for providing similar treatments.

“In the event the central government does not come out with a concrete proposal by the next date of hearing, we will consider issuing appropriate directions in this regard,’’ ruled a bench of Justices B.R. Gavai and Sandeep Mehta last week

The bench was hearing a PIL filed by an NGO — Veterans Forum for Transparency in Public Life, through its general secretary Wing Commander (Retd) Bishwanath Prasad Singh — praying for the SC’s direction to determine the rate of fee chargeable by hospitals across the country from the patients in terms of Rule 9 of the Clinical Establishment (Central Government) Rules, 2012.

The NGO had submitted that the Central Government itself has notified the rates which are applicable to the CGHS (Central Government Health Scheme) empanelled hospitals and had suggested that till a solution is found, the Central Government can always notify the said rates as an interim measure.

The NGO has provided an example that the cost of cataract surgery in a private hospital can range from Rs 30,000 to Rs 140,000 per eye, whereas the rates in a government in a government hospital are up to Rs 10,000 per eye.

The government’s counsel informed the SC that the rules framed in Clinical Establishments (Registration and Regulation) Act, 2010 has been adopted by 12 State Governments and 7 Union Territories and in view of the provisions of Rule 9 of the Rules, of 2012, the rates cannot be determined by the central government unless there is a response from the State Governments/ Union Territories.

The government counsel further submitted that though various communications have been addressed to the State Governments/ Union Territories, there was no response and as such the rates could not be notified.

“The Union of India cannot shirk away from its responsibility by merely stating that communication have been addressed to the State Governments/Union Territories and they are not responding,” said the bench.

Tapan Singhel, Chairman, General Insurance (GI) Council said, “we have always maintained that we need to charge an appropriate cost for customers, whether it’s at the time of taking out a policy or bearing certain expenses at the time of a claim. It is very encouraging to see the Apex court urging the Centre to take a decision on standard hospital rates. We feel that this, along with ‘Cashless Everywhere’ will eventually benefit our citizens, for whom it’s a fundamental right to receive good healthcare.”

However, the Indian Medical Association (IMA) and the Hospital Board of India have cautioned hospitals against accepting the Cashless Everywhere’ initiative, recently unveiled by the by the General Insurance Council in its current format, highlighting the potential risks involved.

There are over registered 40,000 hospitals in the country, which can now offer cashless facilities to all the health insurance policyholders, numbering over 30 crore, in the new system.