The Maharashtra government has made strong recommendations to the centre to remove caesarean surgeries, knee and hip replacements out of private healthcare ambit in the new National Health Protection Scheme (NHPS) pointing that allowing private hospitals may lead to unnecessary rise in such procedures.
In a list of 20 recommendations, submitted late last month, Maharashtra has voiced concerns over extending insurance cover for caesarean procedure, knee and hip replacement to private hospitals. The state government has recommended that such procedures must be limited to public hospitals.
Earlier this year, the centre has finalised 1,354 procedures under the insurance scheme that aims to cover over 10.74 crore families. Specialities such as cardiology, nephrology, oncology, orthopaedics, ophthalmology including cataracts will be included. Rates for caesarean delivery that hospitals will be offered under the scheme is estimated to be around Rs 9,000, that of knee replacement at Rs 80,000 and of hip replacement at Rs 90,000.
Comparatively, caesarean procedures may cost Rs 20,000 onwards in private hospitals and escalate depending on complications in pregnancy. According to doctors, cost of knee replacement can range between Rs 50,000 to Rs 1.5 lakh while hip replacement can cost between Rs 3 to 7 lakhs in private sector.
“We have built an entire system to offer free delivery and maternal care to women. If government has the required facilities, why should we rely on private hospitals,” a senior state official contended while speaking on the condition of anonymity.
Maharashtra officials attached with Mahatma Jyotiba Phule Jan Arogya Yojana, insurance scheme covering 971 procedures in state, said that allowing caesarean procedures in private hospital may cause an unnecessary rise in demand for c-section even in cases where normal delivery is possible. “Already, private hospitals have a higher rate of c-section than public hospitals,” a senior official said.
The rate of c-sections nationally stands at an average of 17.2 per cent as per the National Family Health Survey-4. “World Health Organisation states it should range between 10-15 per cent, but some states in India record 87.5 per cent c-section rates,” said Professor Soumitra Ghosh, who has researched on Maharashtra’s health insurance scheme.
“In health economics there is a concept of supplier induced demand, where doctor decides the surgery for patients. In private healthcare, there is vested interest to influence such demand,” he added.
According to Professor T Sundaraman, dean of School of Health System Studies at Tata Institute of Social Sciences (TISS), services available in public sector should be kept away from insurance unless public sector is unable to handle the burden of it.
“In Tamil Nadu and in Arogyasri insurance scheme, 200-300 procedures are restricted to public sector. Under NHPS, there is recommendation to limit over 700 procedures to public hospitals,” he said. Sundaraman added that certain procedures have “high moral hazards” and since insurance is available, both doctor and patient may agree to go ahead with unnecessary medical interventions.
Speaking on sidelines of the World Health Assembly in Geneva, Union health minister JP Nadda said, “We are going through self-learning processes. We will include learnings from state government in the national scheme. We will try to plug those issues.”
He added that two years after implementation of NHPS there will be changes in government hospitals. “We have told states to give government hospitals the freedom to retain money that comes out of these surgeries. They will have flexible component also, where doctors and paramedic will get extra remuneration if they work overtime for surgeries. This money can be used to strengthen health institutions,” Nadda said.