14 July 2010
By Pushpa Narayan
In a bid to resolve a stand–off between hospitals and public sector insurance companies over the cashless insurance scheme for individual customers, a CII–initiated meeting in Mumbai on Tuesday laid out a 90–day roadmap. The plan includes grading hospitals and fixing price levels for procedures at each hospital, besides enhancing the list of hospitals under medical insurance schemes.
The suggestions are expected to address complaints regarding overbilling by hospitals in some regions and also provide doctors the leeway to determine the right form of treatment. Both parties have agreed to divide hospitals into four categories – A, B, C and D – based on parameters, including bed strength, infrastructure, human resources and results. The grading will be used to develop a standard cost for each category of hospital. “We tried to reason out that it was not fair to have the same cost for a surgery at a 20–bed hospital and a 200–bed one. They have agreed to work on it. We believe this will put the consumer at a much better position,” said Sanjay Rai, director (marketing), Maxhealthcare. A CII committee on health, which met in New Delhi under cardiothoracic surgeon Dr Naresh Trehan last week, had decided that representatives of the hos
For A Solution
The roadmap envisages
- Grading hospitals into four categories
- Fixing price levels for different procedures
- Enhancing list of hospitals under med insurance pital industry should meet officials from public health insurance
The meeting was an attempt to break the stand–off between hospitals and insurance companies over the cashless scheme for individuals. “It was an extremely useful meeting,” said Vishal Bali, CEO, Fortis Hospitals. “We all know that there is no growth for healthcare without insurance. At the same time, we wanted insurance companies to avoid the mistakes that were done in the US,” he said.
Though the insurance companies said they would not immediately reverse the decision to remove some hospitals from their “preferred provider network”, they promised to make reimbursements for all genuine cases.
“But it is the first meeting that has opened the doors for reform in the health sector. They told us patients were unable to pay in cash for treatment following sudden rollback of some hospitals from the network. But we told them how patients suffer because some hospitals charge high rates and exhaust the eligible amount in one shot. The patient has no cover if he falls ill again. Secondly, he pays high premium from the next time,” said G Srinivasan, chairman and managing director, United India Insurance.