Viswanath Pilla Moneycontrol News
Large private hospitals who are hoping for a revision of package rates offered under the Pradhan Mantri Jan Arogya Yojana (PMJAY), so that they may join the scheme, will have to wait much longer.
The Central government has indicated that it is in no hurry to do so , and called the package rates offered under the scheme as rational and realistic.
“The rates for PMJAY have been prepared after detailed deliberations and consultation with states and other stakeholders,” said Indu Bhushan CEO, National Health Agency (NHA), the implementing agency of PMJAY.
“Therefore, PMJAY provides realistic rates for treatment. States also have flexibility to revise these rates within a limit as per the local conditions,” Bhushan added.
“PMJAY engages the private sector through the strategic purchase of designated services at a rational cost. There is no question of privatization of healthcare. The question is not whether the private sector should be involved or not, rather, how it should be engaged to be accessible to the poor on rational terms,” said Dr Vinod Paul of NITI Aayog in the NHA’s newsletter for October .
Paul is one of the key architects of the scheme.
“The package rates reflect the fair pricing without any scope of profiteering. By its basic design PMJAY also promotes and strengthens the participation of public hospitals. The earnings through the PMJAY services will be retained by government hospitals for improving services and incentivising provider teams,” Paul said.
More than 15,000 private hospitals have applied and around 6,000 have been empanelled, with the rest in the process of review.
Paul said almost half of the currently empanelled hospitals are from the public sector.
One top executive of a private hospital chain expressed disappointment, but said they will keep talking to the government for package rates that allow them to ensure better clinical outcomes and patient satisfaction.
The executive’s hospital is yet to get empanelled to the scheme.
“Yes we agree that the PMJAY gets us volumes, but it’s not financially viable for us at the prices offered,” the executive said.
More than 116,000 beneficiaries have been treated since the launch of the scheme on September 23 by Prime Minister Narendra Modi.
PMJAY or Ayushman Bharat, popularly known as ModiCare, aims to provide Rs 5 lakh coverage to 10 crore poor families or nearly half a billion people and is considered an important scheme politically for Narendra Modi to showcase to voters as he heads for the general elections next year.
The scheme will cover medical and hospitalization expenses for almost all secondary care and most of tertiary care procedures. PMJAY has defined 1,350 medical packages covering surgery, medical and daycare treatments including medicines, diagnostics and transport.
Thirty two states and union territories have agreed to implement the scheme, of which 17 have adopted a trust-model, wherein each individual state will form its own trust to manage the scheme. The claims will be disbursed from a corpus created from the central and state government contributions.
Out of the remaining states, eight have opted for an insurance model and the remaining seven for a mixed model.
The governments so far spent around Rs 172 crore as pre-authorisation amount
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