States can consider Ayushman Bharat rates to cap Covid treatment cost — Centre tells SC

New Delhi: The central government told the Supreme Court Wednesday that states could consider the rates fixed under the Ayushman Bharat scheme or the Central Government Health Scheme (CGHS) as a benchmark to determine the price cap on Covid-19 treatment in private hospitals.

Ayushman Bharat provides health insurance cover to the country’s poor and downtrodden. CGHS is accessible to over 35 lakh beneficiaries who are entitled to cashless treatment across the country.

In an affidavit filed before a bench led by Chief Justice S.A. Bobde, the Ministry of Health disclosed guidelines for states to regulate the treatment costs of Covid-19 in private hospitals.

The bench was hearing a PIL filed by advocate Sachin Jain for free or subsidised medical treatment to Covid-19 patients, particularly in hospitals that had received government land at concessional prices. On 14 July, the Supreme Court had asked the central government to frame guidelines regulating costs of Covid-related treatments.

The health ministry, in the affidavit filed in response to the PIL, noted that these guidelines could be followed if a state was considering utilising private healthcare facilities to augment public health infrastructure in its fight against the Covid-19 pandemic.

The guidelines are meant to ensure there is “no over-charging” from patients, according to the government.

It also reiterated its earlier stand that states had the statutory power to regulate private hospitals.

Solicitor General Tushar Mehta referred to the affidavit and said the cost of treatment in these hospitals should be earmarked. However, he added, the “issue of caps on pricing or Covid treatment should be left to the individual state government”.

Private hospitals opposed the suggestion of price caps, especially in cases where patients have insurance cover.

The price caps should also not be made applicable to cases of comorbidity, their lawyers told the court.

At this, CJI Bobde asked the government to urge insurance companies to release dues promptly. “When there is a pandemic, insurance companies cannot keep their hands off,” he said.

The court adjourned the matter for two weeks after private hospitals asked for some time to respond to the government’s affidavit.

Cost ideally should be all-inclusive, says Centre

In its response, the government maintained that the states may consult all stakeholders to determine the price cap.

It said some states have already taken steps to regulate the treatment costs, adding that those who have not could examine the criteria adopted by such states to earmark a price cap.

The affidavit also outlined the parameters that the states may consider while working out the costs.

It noted that the rates should be determined according to the category of the hospital, illness, bed and city.

“The cost ideally should be all-inclusive,” the ministry submitted.

Charges for PPE, generic drugs, consumables, investigations, procedures, treatment for co-morbidities, diagnostics, patient transportation and referrals should be included in the treatment rates, it said.

‘States should give wide publicity to fair rates’

The government stressed on the need for both state-owned and private hospitals to provide treatment based on standard treatment protocols and on the rational use of PPEs as issued by the health ministry.

Also, it suggested that states should have a mechanism to give publicity to fair rates, redress grievances and fix a timeline for such a redressal.

The rates, the government advised, can be reviewed and revised with a possible reduction in the cost of drugs, consumables and with evolving treatment protocols.

It added that there should also be an oversight mechanism for monitoring and enforcing the rates decided. Information about the price cap should be disseminated not just at the state level but also at the district and sub-district levels.

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