The fraternity of private doctors has been cajoled by the Centre to come on board the Ayushman Bharat insurance scheme after assuring them that the procedure rates fixed by the Ministry of Health and Family Welfare are subject to revision.

The scheme plans to extend ₹5-lakh cashless insurance cover to 10 crore families in India.

‘Flawed scheme’

Even up until a week ago, the Indian Medical Association (IMA) maintained that the scheme was flawed. The IMA contested the rates quoted for 1,354 procedures, saying they do not cover even 30 per cent of the cost of the procedure.

MoHFW Secretary Preeti Sudan had said last week that in spite of protests by private doctors, the rates of procedures had been frozen. But now it has been proposed that the Ministry can review it next year: the scheme is likely to be launched in August.

Dinesh Arora, Deputy CEO, AB-NHPM, told private doctors at a meeting that based on costing studies to be steered by NITI Aayog, continual adjustment of benefit packages and their rates is proposed. “But this will only be done next year, after NITI Aayog comes out with the costing studies, not before that,” Arora told Businessline .

The IMA has 3.1 lakh doctors as members; they run small- and medium-sized nursing homes across India, and the Centre could not ignore them. On Friday, Indu Bhushan , CEO of AB-NHPM, who chaired the meeting, discussed the potential collaboration with the IMA to implement the scheme.

The IMA believes that Caesarean sections underwritten for ₹9,000 cannot ensure the safety of the mother and the child, and that safe confinement will require quality drugs as well as the services of an anaesthetist and paediatrician.

To this, Arora said, “The patient will be directed to a private facility for Caesarean only in a scenario where public hospital facilities are not available. The rates remain the same as such for now, though.”

IMA representatives agreed to extend their support for empanelment of hospitals, spreading awareness and beneficiary identification processes. Key issues like timely payments to the hospitals, feedback and grievance mechanism, ease of setting up of IT infrastructure at hospitals for paperless transactions were also deliberated upon.

IMA General Secretary RN Tandon said that while the scheme is good for the public, and the IMA will back it, the government would urgently have to consider revising procedure costs. “We hope these failings are corrected as those who are providing the services should not shut down their workstations because they are not getting enough returns,” said Tandon.

The MoHFW seems to have yielded to the doctors’ demands by making costs flexible. “We need to ensure that the targeted beneficiaries under the AB-NHPM will get maximum benefits and can expand access to quality health services in both rural and urban areas including Tier-2 and 3 cities. This can be done only when the Government, private healthcare providers and associations like the IMA and other industry bodies work together as partners for betterment of health status of the society,” said Bhushan.

Accreditation not a must

Making another concession on quality, Arora said that it was desirable, but not essential, for hospitals to secure the much sought-after but difficult-to-bag National Accreditation Board of Hospitals (NABH) tag in order to be empanelled.