Medical associations and professionals have said they will halt cashless treatments of beneficiaries of the Centre's medical care schemes unless rates are increased and unpaid dues paid, according to a report in Hindustan Times.
Doctors associations, hospitals and nursing homes are yet to be paid at least Rs 1,000 crore for expenses incurred under these schemes, the Association of Healthcare Providers India (AHPI) said.
The schemes will continue but beneficiaries would pay central government Health Scheme (CGHS) rates and then seek reimbursements from the government themselves, AHPI director-general Dr Girdhar Gyani told the paper.
Cashless treatments will thus be halted as a stopgap measure to deal with delayed payments, he added. AHPI has 10,000 members pan-India, including Lilavati, Hinduja, Apollo and Fortis.
This will impact close to 3.8 million beneficiaries, including hospital employees, and pensioners and their families, who receive cashless treatment under CGHS – 3.2 million beneficiaries and Ex-Servicemen Contributory Health Scheme (ECHS) – 550,000 beneficiaries.
The delays are severe and the cycle continues. For CGHS, the wait is at least six months, and hospitals are unable to pay employee salaries or vendor dues, Delhi Voluntary Hospitals’ Forum secretary Dr PK Bharadwaj told HT.
Another issue is that CGHS rates are set via bidding on a pan-India basis. It did not matter if service providers were from Delhi or Muzaffarnagar, everyone has to follow these unsustainable low rates, Dr Girish Tyagi, president-elect - Delhi Medical Association said.
Added to this, the 30-50 percent lower rates negotiated by insurance providers further complicate the issue.
"General Insurance Public Sector Association (GIPSA) has cartelised the market and negotiated arbitrarily low prices with hospitals for empanelment," Dr Mahipal Sachdev, Chairman of Centre for Sight hospitals and President-elect at the All India Ophthalmological Society said.
A health ministry source acknowledged the problem and said additional funds are expected by November-end, which would resolve the issue.
Minister of State for Defence, Sripad Naik, had in Parliament said that an allotment of Rs 3,500 crore is sought. He added that strict disciplinary action would be taken against hospitals that misuse ECHS funds and inflated bills.