Huge gap in private, government hospital Ayushman charges: Study

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Huge gap in private, government hospital Ayushman charges: Study

Translating…

NEW DELHI: Huge disparities — sometimes more than 200% — in the cost of treatment have been noticed between public and private hospitals even as the government has fixed prices of packages under the

Ayushman

Bharat health insurance scheme, triggering further investigations by the National Health Authority (NHA) to validate reasons and formulate guidelines for private hospitals to prevent abuse.

A preliminary analysis into utilisation of neonatal

care

packages in various states showed total spending for critical care was at least three times more expensive in private hospitals than in public hospitals.

Even in the case of basic neonatal care, the cost of treatment in private hospitals was almost double that of public ones.

Over 18,550 hospitals are empanelled under the government’s flagship health insurance scheme. Of this, 54% are private hospitals and the rest are public. However, private hospitals cater to over 60% of beneficiaries under the scheme,which has recorded over 50 lakh

hospital

admissions within a year of its launch.

Higher participation from the private sector makes it even more important for the government to regulate cost of treatment and check any waste and abuse of resources. The scheme is designed to provide free annual health insurance cover of Rs 5 lakh to 50 crore people from 10.74 deprived families.

While average stay was higher in the case of private hospitals, they were also found mostly using special and costlier packages, whereas utilisation of basic packages was common in public hospitals, the analysis showed.

For instance, the median length of stay for cases booked under the Advanced Neonatal Care Package was six days in public hospitals, whereas it was found to be nine days in private hospitals. Similarly, the average duration of stay for critical neonatal care package was eight days in public hospitals but 12.5 days in private hospitals.

“The cost of treatment is directly related to the package being blocked. In most states under consideration, public facilities mostly block the basic package priced at Rs 500 per day, while private hospitals are providing more care under special, intensive, advanced and critical neonatal packages priced at Rs 3,000 to Rs 7,000,” an official said.

The study also found disparities in the amount approved for packages between states. For instance, the average pre-authorisation amount approved in public hospitals of

Jharkhand

and

Meghalaya

was almost twice the average amount approved in

Chhattisgarh

, MP and

Gujarat

.

The analysis also pointed towards availability of better facilities and infrastructure in private hospitals as compared to many public hospitals. Results of preliminary audits conducted by the NHA in some private hospitals showed availability of renowned specialists, well-equipped ICU facilities and round-the-clock availability of doctors and nursing staff. However, officials said further audits and detailed investigations were required to understand the reasons behind the significant gap in the cost of treatment in public and private hospitals.

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