The Supreme Court order standardising rates for medical procedures has the Indian Medical Association (IMA) in a spin. Days after the apex court directed the Central government to implement standard hospital rates within six weeks, failing which it will implement the Central Government Health Scheme (CGHS) rates as an interim measure, the IMA has written to the secretary of the Union ministry of health and family welfare.
IMA wants ministry to consult all states and come out with proposal to standardise rates
The IMA wants the ministry to consult all states and come out with a proposal to standardise the rates. The IMA has also contacted medical associations at the state levels, asking them to seek involvement in all discussions with their respective governments. Not welcoming the SC decision, the IMA said that costing should be done scientifically before fixing any rates. Sources said prices cannot be standardised for big private hospitals and small clinics and that it will spell doom for the health industry.
Dr Rajeev Agrawal, IMA Maharashtra’s treasurer, said that the government wants to benefit private players by fixing the rates of healthcare facilities without understanding its implications. “What is needed is a scientific costing, which has never been done in India. Moreover, the CGHS are determined by a bidding process and hence cannot be considered scientific,” he added.
Rates of treatment at government hospitals are higher than private hospitals
Dr Agrawal further said that the rates of treatment at government hospitals are higher than private hospitals. “For example, an appendicitis procedure costs between Rs25,000 and is Rs35,000 at various facilities,” he said, adding that various state governments, including in Haryana, have not cleared payments under CGHS for the last five years and yet want IMA to follow blind orders on rate fixations.
According to IMA, CGHS rates, in most cases, do not cover even the operational costs. At most of the hospitals, CGHS accounts for about 30% of the business, with the rest coming through private insurers and direct cash payments, with a clear element of cross-subsidy.
IMA will share scientific methodology when necessary
Dr Agrawal said there are a number of variables in healthcare costs. He said IMA will share scientific methodology when necessary. “All state units of IMA have been asked to contribute a minimum of Rs5,000 from each healthcare facility since IMA headquarters are legally taking up the case,” said Dr Agrawal.
“The pricing of services often reflects factors like experience, expertise, and specialised skills. Medical professionals who are experts in their field with more than 20 years and another with less experience will not have the same rates,” said an expert from a private hospital on condition of anonymity
Heart Valve Replacement
Private Rs2 lakh to Rs4 lakh
CGHS Rs1.8 lakh
Discount 40%
Coronary Bypass Surgery
Private Rs95,000 to Rs4.5 lakh
CGHS Rs1.5 lakh to Rs2 lakh
Discount 42%
Hip Replacement
Private Rs2.3 lakh to Rs5.4 lakh
CGHS Rs 82,000
Discount 77%
Angioplasty
Private Rs1.5 lakh to Rs2 lakh
CGHS Rs92,000
Discount 50%
