Why Private Hospitals Are Hesitant to Join Delhi’s Cashless Scheme

More than 50 private and 15 government hospitals in Delhi have enrolled to provide cashless treatment under the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY). Yet, most well-established private hospitals have made the scheme unsustainable for them on financial and operational grounds.

What is restraining private hospitals?

Low reimbursement rates are the prime reason.

The majority of the private hospitals, especially corporate and large hospitals, have termed the scheme's reimbursement rates as being too low. They say that these rates are inadequate to cover the expense of advanced treatments and procedures, and hence leave the hospitals in the red.

Package rates for complicated procedures are not feasible for large setups with large overheads related to equipment, personnel, and infrastructure, states Dr. Sunil K Khetarpal, Association of Healthcare Providers India (AHPI).

Frustration is caused by delayed payments.

Apart from the problem of prices, the problem of delayed payments has also been highlighted by other states rolling out AB-PMJAY. This has further demotivated the use of top-end private facilities.

AHPI, on behalf of over 15,000 private hospitals like Fortis, Apollo, Medanta, Max Healthcare, and Manipal, has approached the Delhi government to initiate the process to negotiate these issues.

Need for reforms: better rates and faster redressal

AHPI Director General Girdhar J Gyani wrote to Delhi Chief Minister Rekha Gupta, underlining the need for a standalone grievance redressal mechanism.

Dr. Narin Sehgal, Medical Director, Sehgal New Hospital and Secretary, AHPI Delhi, said that while AB-PMJAY is India's biggest health insurance scheme, several hospitals are not keen to take it on because there are unrevised rates and there is a poor history of implementation, with several instances from earlier days of the programme in the form of the Central Government Health Scheme (CGHS) being cited as examples.

Scheme launch in Delhi: A slow rollout

To date, only 67 of the over 1,000 Delhi hospitals are participating in the scheme. These include top government hospitals like  Lok Nayak, Deep Chand Bandhu Hospital, Rajiv Gandhi Super Specialty Hospital, and Delhi State Cancer, and some private hospitals like Dharamshila Narayana Superspeciality Hospital, Metro Hospital & Cancer Institute, and Sri Balaji Action Medical Institute.

Most of the private hospitals included in the list are located in the New Delhi district and specialize in services like oncology, general surgery, eye care, obstetrics, and gynecology.

Benefits of the scheme to patients.

AB-PMJAY provides assurance of cashless treatment for 1,961 procedures across 27 specialties. It covers the costs of hospitalization, ICU days, surgery, medicines, and diagnostics. Delhi has assured 2.35 lakh families for coverage under the first roll-out phase.

Bottom line

While the Ayushman Bharat scheme is in the correct direction towards universal healthcare access, its success in Delhi will depend upon getting the confidence of private hospitals, equitable reimbursement, and a speedier payment cycle.

(Input from various sources)

(Rehash/Muhammad Faisal Arshad/MSM)