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Imagine a patient lying on a hospital bed in excruciating pain and in desperate need of a major medical procedure. A life is at stake, but rather than have an experienced specialist attend to the patient, a doctor, who is just off the block, arrives at the patient’s bedside.

To the consternation of the patient’s relatives and friends, the hospital administration says it has no choice but to depute a newbie since insurance companies are unwilling to foot the entire cost of treatment.

It is precisely this scenario that the All Hospitals Association, a group of 30 major and small hospitals in the city is, is striving to avoid.

The hospitals are up in arms over a ‘fixed price list’ released by four major insurance companies which they are willing to pay for a number of major medical procedures in cases of cashless policies.

The hospitals contend that the prices issued by the insurance companies — National Insurance Company Ltd, New India Assurance, United India Insurance Company and Oriental Insurance, who together account for more than 80 per cent of the market — are far below the actual cost of treatment and would push them into the red.

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At a meeting last week (Aug 16), the hospitals association decided to push for a collective meeting with all four insurance companies to amicably resolve the issue.

Medical practitioners say Pune has been given a raw deal as the rates issued by the insurance companies are far lower than those suggested for Mumbai and Navi Mumbai. Moreover, they allege that the insurance companies are unwilling to hold a collective meeting with the hospitals association.

"The rates for Pune are far lesser compared to other cities such as Mumbai and Navi Mumbai," said Dr Nitin Bhagali, head of hospital board, Indian Medical Association. “Pune is as costly a city as Mumbai. In fact, electricity charges and property tax is higher here. The rates that these insurance companies have given us will not even help us break even."

Bhagali admitted that patients could receive substandard treatment and the likelihood of them being discharged sooner, is high. "There are chances that the hospitals may hand over the case to newbies as against specialist doctors as their (junior doctors) rates are lower," Bhagali said.

Doctors say hospitals in the city are at the receiving end even in terms of the Central Government Health Scheme (CGHS), despite the city having a high density of central government employees.

"Uniformity in rates is an excellent idea, but the rates have to be fair," said Manisha Sanghvi, president of All Hospitals Association. “Besides, they also have to consider the size of the hospital while deciding the rates."

Bomi Bhote, the CEO of Ruby Hall Clinic where the meeting was held, revealed that insurance companies were talking to hospitals individually. “None of the major hospitals have agreed to their proposals," he said.

When contacted, K Kedareshwar, regional manager of National Insurance Company Ltd, refused to comment saying he was not authorised to speak to the press. The rates issued by the insurance companies are likely to kick in from October this year under their new ‘Preferred Provider Network (PPN)’ scheme.

Pune Mirror
23 August 2013, Pune.

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