“Cashless everywhere”, ease of hospitalisation initiative, runs into hiccups 

The “cashless everywhere” initiative to ease hospitalisation woes for patients has run into difficult terrain, a little over a month after it was announced by the General Insurance Council.

Doctors have pointed to difficulties in aligning products (lenses etc) and procedure rates with that outlined for reimbursement by health insurance companies, leading to irate patients who face the prospect of having to partly pay for their procedure, despite having health insurance coverage. Hospital representatives told businessline, off record, that they were not under the “jurisdiction” of this diktat, which they said needed more clarity.

The “cashless everywhere” initiative, launched in late January, allowed patients with health insurance coverage to avail treatment at any hospital and not just those institutions mentioned in their policy.

In a separate development meanwhile, the Supreme Court has asked the Centre to fix treatment charges at hospitals, across the country. The Centre has been given six weeks for this.

Pointing out that it’s the State’s responsibility to deliver healthcare, Indian Medical Association (IMA) President Dr RV Asokan, cautioned that an insurance-driven model could interfere with the doctor-patient relationship, as care would be dictated by organisations that are commercially oriented.

IMA template

Explaining the challenges involved in standardising the rate for medical procedures across hospitals, IMA- Hospital Board of India’s Chairman, Dr AK Ravikumar said, there are multiple variables – from the type of product, length of treatment time etc. The cost of lenses for the eyes, for example, vary from ₹10,000 to a lakh, he said, adding that a patient requiring a high-end lens with more features (and with insurance cover for it), may have to settle for a lower-priced lens, under the proposed initiative.

The IMA has created a template based on specifications outlined by the Centre, the Clinical Establishments Act etc, he said, so rates can be standardised for different hospitals depending on their individual capacities and services. It requires a scientific approach, says Dr Ravikumar, calling for a wider discussion on this.

The IMA- HBI advisory to members, points out that cashless payment should be for the actual treatment (as opposed to a standard package rate). Further, it pointed to “a one-time temporary MOU (memorandum of understanding) between insurance company and hospitals”, that lacked clarity. “Do not sign MOU with packages, discounts, free bees, etc and do not compromise on quality health care to patients.” the IMA-HBI said.