Press Release on Cashless not yet resolved – CII National Committee on Healthcare is in dialogue with PSU Insurers
Cashless not yet resolved- CII National Committee on Healthcare is in dialogue with PSU Insurers
New Delhi, India, August 20, 2010: After the CII members’ meeting with representatives of Raksha TPA on 12th August in Delhi, Hospitals in Delhi have worked out the packaged rates for 42 procedures, submitted these to nodal TPA of PSU insurance companies and are waiting for a response.
None of the major super-specialty hospitals including Medanta have yet signed off with TPA on their packaged rates for GIPSA Insurance Companies.
Once cashless is restored in the empanelled hospitals, in the second phase, Hospitals and Insurers along with other stakeholders of the health insurance ecosystem and the competent authority would work on a classification of hospitals, which would be agreeable to all.
Private Providers are committed to patient care, have invested heavily in creating world-class infrastructure and are consistently raising the standards of care for the betterment of health services in India. Mr. Shivinder M. Singh, MD, Fortis Healthcare said “There will always be a differential in the levels of care and services provided by hospitals for a single type of illness. This differentialis a function of structures, processes and outcomes. A scientific analysis of all these parameters is essential to grade hospitals”
The cost of delivery is a factor of the input costs and takes into account patient safety and clinical outcomes. The variance in the cost structures will therefore lead to a variance in price structures. To create a universal price point for a single procedure for all providers, irrespective of grading, will lead to sub-optimal patient care.
CII recognizes that Insurance Providers and Hospitals need to work together to ensure that the right care at the right cost is provided to patients, which increases the viability of both the insurance companies and the providers.
Dr. Sanjeev Bagai, CEO, Batra Hospital and Medical Research Centre, stated that “It is essential that a comprehensive exercise be undertaken of grading hospitals based on their infrastructure, clinical expertise, technology base, clinical outcomes, competency of para-clinical man power, accreditation & standards of care is done. This grading or categorization of hospitals should then translate into pricing of procedures in each grade. Premature conceptualization or inference of this complex process, must be avoided. A broad consensus & dialogue is of paramount importance.”
Patient-centric insurance policies should also be available, with options for higher reimbursement / premiums based on better service quality, criticality of illness, infrastructure and other distinguishers. Remodeled insurance products will ensure “responsible” use of insurance coverage by the consumer. A new framework should provide procedure-based limits and introduce “co-pay” beyond certain limits. The consumer must be given a “choice”.
CII feels there is a need to arrive at a common action plan and appreciate each others’ positions to resolve the misunderstanding between Insurers and providers, through a time bound programme lead by a Task Force that lead to restoration of public confidence.