New Delhi:Many states in India have not defined insurance packages to treat COVID-19 under Pradhan Mantri Jan Arogya Yojana (PMJAY). In effect, private hospitals across India are finding it difficult to process the treatment claims made under PMJAY.
Not having a clear idea what package to claim for COVID-19 and what the treatment cost is, private hospitals in many states are in complete confusion. The fear of no recovery of such claims and uncertainty of the cost of such treatments is adding to their problems. As a result, many private hospitals, for insurance purposes, are categorising COVID-19 patients under ‘respiratory problem / failure cases’.
“Treatment for COVID-19 is free in government hospitals. But this is not the case in the private hospitals. In most states, there is no defined COVID-19 package under PMJAY. Most private hospitals are confused about how to register COVID-19 cases. This is why patients are being mostly categorised under respiratory illness,” said a senior official of a private insurance firm.
“Further, people are not sure about the cost of treatment. If there is a package in PMJAY, the poor people will at least have an idea about the cost of treatment,” the official added.
A look at the reasons why private hospitals are confused... Under PMJAY, ventilator charges are mostly around Rs 4,500 per day. However, in case of COVID-19, there are additional costs related to protective equipment, which may go up to Rs 7,000-8,000 per day.
Read:Centre's lockdown strategy has miserably failed: Rahul Gandhi
According to an Indian Medical Association (IMA) official, most state governments, even after two months of lockdown, are still under the process of getting approvals of the package from National Health Authority (NHA).
On its part, the National Health Authority (NHA) is trying to ensure that prices remain affordable while maintaining quality. The price of RT-PCR test, for example, has been negotiated by many states at rates below Rs 4,500 that the Indian Council of Medical Research (ICMR) has set. NHA is the nodal agency for implementing PMJAY.
When reached for a comment, Dr Indu Bhushan, CEO of PMJAY and NHA said: "NHA has been persuading all the state governments to negotiate with private hospitals on COVID-19 treatment prices.”
Read:Domestic Flight Resumption: What numbers say
Dr Bhushan however admitted that the bulk of the COVID-19 treatment is being done in government hospitals. “It is a reality that PMJAY hasn’t had a significant role to play in COVID-19 so far. But if there is a surge in the number of cases, the public sector may not be able to take care of them all. Then the number of cases in the private sector is set to increase,” he said.
Dr Bhushan agrees that most private hospitals are under deep financial stress, seeing huge reduction in footfalls. Many private hospitals are struggling to find working capital to provide salaries to their employees. “I hope that all state governments negotiate well with them,” he said.
Pertinently, all treatments under PMJAY have seen a steep fall in the last two months. From a monthly average of 7.4 lakh hospitalisations and healthcare procedures between August 2019 and February 2020, the figure fell by 57 per cent to 3.2 lakh in March 2020. It further plunged 84 per cent to 53,000 in April.
NHA attributes this steep fall to lockdown, the patients' own fears of seeking care during this time, and the fact that many government hospitals have become dedicated Covid-19 hospitals. However, the numbers have fallen by only 10-15 per cent for critical treatments like dialysis, chemotherapy, high risk deliveries.
Read:COVID-19 India tracker: State-wise report
