Page 12 - Insurance Times June 2024

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Private hospitals cut Ayushman services as payments consumables and some pharmacy
items where the health panel earlier
lapse had advised discount of 20% and 10%
Private sector hospitals in many states have reduced their services to ben- on medicines and consumables and
eficiaries of the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB- asked the hospital to refund Rs 5,800.
PMJAY) due to payment delays amid insufficient fund allocations from state The chairperson said that the hospital
governments towards the health insurance scheme. replied that the Calcutta High Court

The scheme, launched in 2018, is jointly funded by the Centre and states in earlier had said that the commission's
the ratio of 60:40, with the union government allocating Rs. 7,500 crore to order was not binding. Banerjee said,
PMJAY this year. Officials from NITI Aayog, health ministry, and private "The HC ruling was only for fixing of
hospitals who held a review meeting of the scheme on 1 May raised con- rates and not on the discount and also
cern over the inadequate release of funds by states for the insurance scheme, that the commission had approached
persons aware of the matter said. the HC division bench where the mat-
ter is pending."
"The problem of untimely payments to the hospitals arose when some states
like Telangana, and Andhra Pradesh merged their state health scheme into
the PMJAY," said Girdhar Gyani, director general, Association of Healthcare Health premium jumps by
Providers of India (AHPI). which represents majority of healthcare provid- up to 50% in a year; 'set
ers in India. The inordinate delay in receiving reimbursement has hampered
the cash flow of these private hospitals and created serious operational is- to rise further'
sues, Gyani said. After the 25-50 per cent rise in the
health insurance premium in the past
The reduced participation of private hospitals in the Ayushman Bharat
scheme could severely impact patients, especially as a brutal heatwave one year, insurance companies are
sweeps across many states, triggering a surge in heat-related illnesses. likely to hike health premiums by an-
other 10-15 per cent in the coming
Hospital rejects health In this case, Pritam Saha had moved months.
the health panel against the hospital. The reason for another round hike is
panel refund order
Saha's relative underwent a planned likely to be the IRDAI decision to
The Apollo Multispecialty Hospital change the norms, said an industry
surgery covered by insurance. The to-
Kolkata told the West Bengal Clinical tal bill was Rs 3.2 lakh, of which the source, adding, that it was "a surprise"
Establishment Regulatory Commission TPA approved Rs 2.3 lakh and the rest that IRDAI had allowed insurers to jack
(WBCERC) that the hospital was not was paid in cash. up premium steeply in the past two
bound to abide by a health panel direc- years.
tive asking it to refund Rs 5,800 for Health panel chairperson Ashim Kumar According to a survey conducted by
overcharging on consumables and Banerjee said the panel found that the LocalCircles, 52 per cent personal
medicines. hospital had not offered discount on

12 June 2024 The Insurance Times