Health schemes: CII plans study to suggest model for proper reimbursement structure

Kolkata, March 29 The Confederation of Indian Industry (CII) is making attempts to end a rift between private hospital chains and the Union government on fresh tariffs for the Central Government Health Scheme and the Ex-Servicemen Contributory Health Scheme (ECHS) for retired defence personnel.

After the government slashed the rates it pays to private hospitals for treating beneficiaries of the two schemes, speciality and superspeciality hospitals like Apollo have begun refusing to treat CGHS patients. Apollo, Calcutta Medical Research Institute, Yashoda and Global have not signed fresh Memorandum of Understanding with CGHS over the revised tariffs announced in October 2007.

The CII plans a study to be completed within two months to suggest a model for speedy and proper reimbursement structure for the treatment of CGHS beneficiaries in private hospitals. “We are conducting a study with CII and ICRIER,” said Gautam Sehgal, treasurer of the Indian Healthcare Federation.

Apollo Hospitals chairman Prathap C Reddy, who is also the chairman of CII committee on healthcare, said the new rates are almost 40 per cent lower than earlier rates. “The new rates make it unviable for private hospitals to treat CGHS patients,” said Reddy.

Industry sources said that it takes almost a year or more to be reimbursed for CGHS patients.

Amit De, chief operating officer of Meridian Medical Research and Hospital said, “About 20 to 30 per cent of the bill amount is discounted as some essential items are not covered by CGHS.”

Sehgal said the study would suggest pitfalls in the CGHS and ECHS system.

“It would also suggest newer therapies not covered by the two government agencies,” he said.