In a first, the Maharashtra government has capped the cost of medical treatment in private hospitals for people who are not covered under insurance. For those who have medical insurance, the capped prices will come into force after they have exhausted the cover. The decision comes after several patients suffering from COVID-19 and other ailments highlighted the exorbitant cost of treatment at private hospitals at the time of a pandemic.
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The notification issued by Principal Secretary Pradeep Vyas states that hospitals should charge the lowest rates for procedures as per their pacts with the insurance companies. Hospitals that don’t have tie-ups with any insurance network will have to follow the rates fixed under the notification. The document has provided the capped prices for more than 130 different procedures including general surgeries, cardiac, obstetric and gynaecology, ophthalmology, orthopaedic and neurosurgery. For example, an angiography has been capped at ₹12,000, angioplasty with one stent has been capped at ₹1.2 lakh, dialysis has been capped at ₹2,500, and a total knee replacement has been capped at ₹1.6 lakh.
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A majority of the hospitals in Mumbai, Pune, Navi Mumbai, Panvel and Thane are members of the General Insurer’s Public Sector Association (GIPSA) - Preferred Provider Network (PPN) and have fixed treatment package rates which have been worked out based on the type of hospital, infrastructure, facilities etc. Other hospitals in the State have agreements with Third Party Administrators (TPA) under which the treatment rates and packages are designed. “As per the notification, if a non-insured patient goes to any of these hospitals, he or she should be charged as per their lowest treatment packages, irrespective of whether the patient is admitted in a general or deluxe category,” explained Sudhakar Shinde, chief executive of the State-run health insurance scheme.
He said that for those who have insurance, these rates would apply after they had exhausted their cover. “Hospitals levy charges as per their rack rates after patients exhaust their medical insurance cover. That cannot be done now,” said Dr. Shinde, adding that the notification had invoked the Epidemic Diseases Act, Disaster Management Act, Maharashtra Essential Services Maintenance Act, Mumbai Nursing Homes Registration Act and the Bombay Public Trusts Act. “We are in difficult times right now and have urged all the hospitals to comply with these norms,” he said.
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A chief executive of a Mumbai hospital said that it would be impossible for them to sustain their financial viability with such price caps. “We are struggling with COVID-19 patient encounters that have led to the staff being quarantined,” said the CEO, speaking on the condition of anonymity. “There is an additional burden of testing the staff, arranging their transport during the lockdown, and continuing to pay their salaries even when they are off duty while in quarantine. Hospitals are already facing many losses,” he added.
The State’s notification, however, did not elaborate on how the government would control the cost of COVID-19 treatment. While the Brihanmumbai Municipal Corporation has capped the rates of beds for COVID-19 patients at ₹3,000, the bills of many patients requiring critical care have exceeded ₹5 lakh. In a media statement, Health Minister Rajesh Tope said that some hospitals had charged ₹1 lakh to COVID-19 patients for one day. He asserted that the notification would help in controlling exorbitant charges by hospitals.