A day after the state government issued a notification for private hospitals to cap surgery costs for both coronavirus-infected and other patients, several hospitals have reached out to Chief Minister Uddhav Thackeray and urged him to either revoke or dilute the order. The private hospitals claimed that the revised rates would lead to huge losses.
Under the new schedule of rates, released on April 30, the state government had fixed the cost for medical procedures under the Epidemic Diseases Act, 1897, for patients with no insurance cover. While the cost of angiography was fixed at Rs 12,000, hospitals were directed not to charge more than Rs 75,000 a normal delivery. A valve replacement surgery, under the new order, would cost a patient Rs 3.23 lakh, a permanent pacemaker implantation Rs 1.38 lakh, and a cataract surgery Rs 25,000 among others.
Items like a pacemaker, personal protective equipment (PPE), intraocular lenses, stents, catheter, balloon, medical implants, and consumables cannot be charged over 10 per cent mark up on net procurement cost. Health officials said the new rate was likely to continue until the coronavirus outbreak subsided.
Explaining the need for putting a cap on surgery costs, Anup Kumar Yadav, director of National Health Mission, Maharashtra, said they had received complaints and tip-offs from patients about being charged Rs 8-10 lakh by private hospitals for COVID-19 treatment. Dr Sadhana Tayade, director of Directorate of Health Services, also said a series of complaints had prompted the state government to take action.
On April 16, officials said, a COVID-19 patient, aged 41, was asked to deposit Rs 1 lakh before admission at Nanavati hospital. Within eight days, the bill rose to Rs 6.5 lakh. While the patient had health insurance, the company, New India Assurance, had refused to cover the expenses as Nanavati hospital was not listed with them.
Eventually, after the intervention of the Insurance Regulator Development Authority the insurance company agreed to cover up to Rs 7 lakh.“The doctors were no doubt very good, they saved my son’s life. But we are retired, middle-class people. The hospital bill was so huge that we could not handle it on our own. We had a lot of problems coordinating with the insurance company and the hospital,” the patient’s mother said. On Saturday, his bill touched Rs 9 lakh, the family said.
Activist Abraham Mathai, who had intervened to help the family, said a complaint was submitted with the state health minister in the matter.
“There is a need to convert multiple private hospitals into COVID centres so that patients are treated, and not denied treatment. Currently, there are very few private hospitals designated to treat COVID patients. Insurance companies must also be told to expand their policy to all hospitals during such times,” Mathai said. At least three private hospitals had refused to admit the 41-year-old patient citing non-availability of bed before he was finally admitted to Nanavati hospital. A query sent to Nanavati hospital about the bill, however, yielded no response.
The revised rate chart, state officials said, was prepared in two days this week to curb the huge profit margins private hospitals were making from COVID-19 patients, despite the pandemic. The new order mandates that a hospital can only charge up to 10 per cent in addition to the procurement cost of a PPE — it means, for a PPE bought for Rs 1,000, the hospital cannot charge more than Rs 1,100 from a patient. While hospitals that have an agreement with the General Insurance Public Sector Association (GIPSA), have been disallowed to charge beyond the lowest price quoted for a bed as per the association’s rates. GIPSA is an association of government insurance companies that fixes package rates for surgeries in hospitals.
Several private hospitals, meanwhile, have claimed that they would have to incur huge losses if the new rates were not diluted and have reached out to the state government seeking relaxation. Hospitals have pointed out that due to COVID-19 outbreak, elective surgeries, which account for about 80 per cent of hospital revenues, had already been halted.
Maharashtra Health Minister Rajesh Tope said the government was, so far, firm on its decision to implement the order.
“If hospitals are exorbitantly charging then why should they be spared. Our objective is hospitals should earn, but to the limit of 5-10 per cent at this point. We are not asking hospitals to provide their service at a loss, we only want them to do it fairly.”
He added that he, too, had received multiple calls of overcharging. “If hospitals do not follow this notification, action will be taken under the Act,” Tope said.
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