The danger for private hospitals empaneled under Ayushman Bharat scheme is unfolding slowly. However when private hospitals do not listen to reason and rush to sit in the lap of the Government, the consequences are predictable. The Government had brilliantly brought out a populist scheme to garner votes. It was very well marketed. Private hospitals hesitant to join the scheme were arm twisted by District administrations to do so. The scheme was so conceived that the onus of providing the promised service fell on the private hospitals and the luxury of making delayed payments or no payments or of imposing fines was retained by the administration. The credit for rolling out the scheme was garnered by the ruling party during the 2019 elections. The private hospitals which agreed to do the needful in national interest were trapped in a quagmire which is easy to get into but difficult to get out of. With signed agreements they are not at liberty to walk out of the scheme now. If they violate the terms , stringent punishments including cancellation of registration under CEA is threatened. Through various laws the Government has conveniently nationalized the private hospital industry, forcing them to do its bidding without itself investing a single penny.
The scheme is flawed at the very inception. Insurance model is not the appropriate model for healthcare in our country. What was needed was development of good government infrastructure, hiring of doctors and supportive staff at massive scale to look after health needs from primary to tertiary level of care. Anyone going to the Government infrastructure should then have been treated free of cost. This is what has been reiterated by the honorable Supreme Court while including right to health as a fundamental right under the ambit of article 21 of Indian Constitution. The Paschim Bengal Khet Mazdoor Samiti vs State of West Bengal judgment had categorically said that it was the duty of the state to provide medical services to the citizens and lack of resources could not be an excuse. This however requires investment by the Government into healthcare on a scale which is unprecedented and beyond the scope of this Government (or any Government for that matter) given our burgeoning population. The Ayushman Bharat scheme floated with its less than Rupees 15000 crore allocation is dependent on the assumption that only a fraction of the population claimed to be covered will actually utilize the services promised.
Corruption in healthcare has its genesis with the advent of insurance in healthcare. When power to reimburse hospitals is handed over to accountants and clerical staff this was bound to happen. Service provided by hospitals is assessed , audited and evaluated by these clerks and accountants for its indication , quality and duration of treatment given by doctors. Hospitals do not get the rates for services rendered without keeping the administrators happy and try to recover their losses by corrupt practices in the subsequent Bills. Everybody knows what is going on and system works fine till the time there is no moolah remaining in the scheme hence no payments to be divided with the insurers, third party administrators and authorities. This has happened periodically in various other Government schemes leading to private hospitals taking losses of crores in unpaid bills. Ayushman Bharat scheme has taken this to a new level where the rates prescribed are lower than CGHS rates for most procedures and monitoring is done through district administration which otherwise has powers to arm twist the private hospitals to toe the line or else face closure under various laws .
It would require a brave soul to invest into healthcare under these circumstances. The combination of Inspector Raj unleashed through various laws, compliance of multiple licensing formalities, along with no or low payments through Government schemes is slowly but surely decimating the non corporate multispeciality hospitals who do not have sufficiently deep pockets or staying power.
Dr Neeraj Nagpal
Convenor,Medicos Legal Action Group, Managing Director MLAG Indemnity,
Ex President IMA Chandigarh
Director Hope Gastrointestinal Diagnostic Clinic,
1184, Sector 21 B Chandigarh