Maharashtra: State puts cap on charges pvt hospitals can levy on patients

For hospitals not attached to GIPSA package rates, the notification provides a schedule of rates beyond which they cannot charge. (Representational Photo)

The state health department has put a cap on charges private hospitals can levy on patients, stating that it has received “a number of grievances of exorbitant amount of money being charged by healthcare providers”. The new schedule of rates is applicable for treatment of both COVID-19 and non-COVID patients. State officials said they came across instances where patients were overcharged because hospitals are selectively admitting patients based on staff and doctor availability in light of the pandemic.

An official said patients who had no insurance policy were being charged steeply. “We came across cases where package costs offered are high, patients are not getting admitted in hospitals,” said Dr Sadhana Tayade, director, Directorate of Health Services.

Hospitals in Mumbai, Thane, Navi Mumbai, Panvel and Pune, which have agreement on treatment packages with General Insurance Public Sector Association (GIPSA), cannot charge more than the lowest bed category rates for patients. GIPSA is an association of government insurance companies that fixes package rates for surgeries in hospitals.

For hospitals not attached to GIPSA package rates, the notification provides a schedule of rates beyond which they cannot charge. For instance, an angiography should not cost more than Rs 12,000, a normal delivery not more than Rs 75,000, a valve replacement is capped at Rs 3.23 lakh, a permanent pacemaker implantation at Rs 1.38 lakh, a cataract surgery at Rs 25,000 and so on.

Items like pacemaker, personal protective equipment (PPE), intraocular lenses, stents, catheter, balloon, medical implants, consumables cannot be charged over 10 per cent mark up on net procurement cost. This means if a PPE costs Rs 100, hospitals cannot charge a patient more than Rs 110.

Hospitals said they are studying the notification and are going to interact with the government over this. Dr Khalid Shaikh, owner of Sai hospital, said he is already following the rates fixed by GIPSA. “Several hospitals charge beyond GIPSA rates. This notification will force them to charge a normal patient as per GIPSA rates,” he said.

The notification stated that charitable hospitals have to reserve 10 per cent beds for indigent patients for free and another 10 per cent for weaker section of the society under the Bombay Public Trusts Act, 1950.

Dr Gautam Bhansali, consultant with Bombay hospital, said the capping may force hospitals to opt for inferior quality surgical supplies and consumables. “Hospitals are already going in losses, they are in a dying situation. This will further hit private health sector. Private sector should have been consulted before the notification came out,” Bhansali said.

Lilavati hospital currently does not follow GIPSA package rates. “We will follow whatever government says as we do not want patients to suffer at this time of economic slowdown,” said chief operating officer Dr V Ravishankar. Ravishankar, however, added that rates were never increased after the outbreak in Mumbai. “We are admitting non-COVID patients in common and economy ward too at the same charges as before,” he said. He added that the hospital is following protocol to reserve beds for indigent patients. “In fact there is one Covid patient on ventilator who we are treating for free,” he said.

Dr Avinash Supe, director of Hinduja Hospital (Khar), said this notification may have to be followed for a few months until the outbreak subsides. “After the Covid outbreak began, there is 80 per cent reduction in beds’ occupancy. All elective procedures have been halted,” he said.

Dr R B Dastur, medical director of Bhatia hospital, said this notification will create problems. “Every day we are getting new notifications, it is difficult to operate. In a normal operation theatre there are not less than 5-6 staffers. Their personal protective equipment cost is high. Now we can’t even test a patient for COVID-19 if he is asymptomatic. So, for every patient PPE has to be worn, imagine the cost to hospital for this,” he said.