Fixing of rates for various procedures in private hospitals, under the recently launched Arogya Karnataka, may take longer as the State Health Department is working on integrating the State’s scheme with the Centre’s Ayushman Bharat.
Meanwhile, private hospitals, who are continuing with the rates fixed for the seven erstwhile health schemes, are concerned over the low pricing of procedures.
Sources in the Private Hospitals and Nursing Homes’ Association (PHANA) said although the Arogya Karnataka scheme has been rolled out, clarity on pricing and empanellent is lacking.
“The scheme was launched just before the elections and modalities of implementing the scheme had not been worked out. There was a delay because of the model code of conduct, and now with the new government yet to settle down, a lot of issues have to be sorted out,” said an office-bearer of the association.
Rates of various procedures that have not been revised for some years need to be reworked as the existing prices are very low, he said. “Successive governments have been ignoring our plea for price revision as every political party wants to gain mileage by providing healthcare at lower rates. The parties are using private hospitals for vested interests during the election season,” the office-bearer alleged.
Moreover, private hospitals who had been empanelled for the seven health schemes before they were subsumed with Arogya Karnataka have been asked to continue till August at the existing rates. “If the same rates continue beyond August, we will have to re-think about continuing being empanelled,” he said.
Admitting that there are issues, especially with regard to pricing that need to be sorted out, PHANA president (Elect) C. Jayanna said the association members will discuss and decide on the future course of action.
Ajay Seth, Additional Chief Secretary (Health and Family Welfare Department), said, told The Hindu that the department was working on integrating the State’s health scheme with the Centre’s Ayushman Bharat. “We are looking at co-branding Arogya Karnataka with Ayushman Bharat. If this is not done there will be an overlap. We cannot tell people that if you are covered under the Centre’s scheme, you are not eligible for the State scheme. We have already raised the issue with the Union Ministry of Health and are awaiting its response.”
The Centre had already fixed rates of various procedures for private hospitals under Ayushman Bharat and again revised the rates last week. “In the wake of this, we are reviewing the Centre’s rates before setting up a committee and finalising rates for procedures in Karnataka,” he said.
On the referral system under Arogya Karnataka, based on which a patient can avail treatment in a private hospital, Mr. Ajay Seth said all taluk hospitals and district hospitals had been equipped to provide secondary care. “Only if there are no facilities available in these hospitals to provide complex secondary and tertiary care, the patient will be referred to a private hospital,” he said, adding that there is no requirement of referral for emergency treatments.
The Health Department recently issued a Government Order simplifying the implementation guidelines of the scheme. According to the new guidelines, the 62 lakh families who hold Rashtriya Swasthya Bima Yojana (RSBY) cards can avail RSBY secondary treatments in the empanelled hospitals without any referral from a government hospital till August 31, based on their RSBY cards.
Other patients can avail treatment (complex secondary and tertiary) based on their BPL card and Aadhaar card (BPL patients) and Aadhaar card (APL patients) only in empanelled hospitals without a formal enrolment under Arogya Karnataka. The requirement of Arogya Karnataka enrollment and the Arogya Karnataka cards will be brought in the next few months after setting up the enrollment facilities in all districts, the guidelines stated.