Bengaluru: The response from private hospitals to the government’s much-hyped Arogya Karnataka health insurance scheme has been lukewarm at best, as only 10-12 per cent of them have been empanelled. Medical experts say the rates are “just not sustainable”.
Dr Govindaiah Yatheesh, president, Private Hospitals and Nursing Homes Association (PHANA) said the “nonviability” of providing quality healthcare under the scheme is a big turn-off, while Dr Alexander Thomas, president, Association of Healthcare Providers-India (AHPI), said hospitals are “unhappy with the terms of the scheme” and only a small percentage of private hospitals are seeing patients under the scheme.
Dr Pavan Patil Gadag,managing director and minimal access surgeon at NB Patil Hospital, one of the few hospitals that treats patients under the scheme, said, “Sadly, the government does not hear service providers’ views while implementing these schemes. Hospitals incur losses because of the low rates.” Dr Gadag, who is also public relations officer of Indian Medical Association, Karnataka chapter, said the hospital treats over 600 adult and 200 neonatal patients a year under the scheme.
Dr Thomas says that under the scheme, almost everybody gets free treatment. “Ideally, those who can, should make co-payment.”
Meanwhile, the referral system which Karnataka has adopted has become an impediment for patients seeking care. Getting government doctors to issue referral letters leads to collisions between government and private healthcare systems. There have been instances where patients have died while family members were made to run from pillar to post. Public health activists say in other states, patients can just walk into private hospitals and get treated under the scheme. They say Karnataka must follow suit.
Dr Sylvia Karpagam, public health doctor and researcher from Bengaluru, feels the model should be scrapped.
“There should be better investment in public health facilities from primary to tertiary care,” she told to a news agency. “This health insurance model will not serve patients because private health facilities will not be satisfied even if their margin of profit is high,” said Karpagam, adding, “Whether the costs are borne by the state or patients, they are still exorbitant.”
However, Dr Thomas believes Ayushman Bharat is one of the best insurance schemes “in the world”. It is just that it needs an overhaul. “More than 70 per cent of hospitals fall under the private sector and this statistic cannot be ignored,” he said.
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