As the insurers have decided to pay less money to the city doctors and hospitals for different treatments, you may soon not be able to go for expensive treatments with the latest technology and equipment.
The new norms proposed by over 12 third-party administrators (TPA) and government-run insurance companies offering cashless mediclaim, has left the city's medical fraternity shocked. Doctors fear that the changes would give insurance companies almost dictatorial powers not only over policy holders but also over the doctors treating them.
The doctors say the changes will restrict the patients' choice to a few doctors and hospitals who have accepted the new rates for treatment of different ailments.
The TPAs and the government-run insurance firms are now offering hospitals fixed amounts for treatment of different illnesses. But the policy holders will still pay the same premiums for different policies. The slashed rates are around 35 percent lower than those offered to hospitals and private doctors offering their services to hospitals in Mumbai and Delhi.
"Under the cashless mediclaim MoU offered to hospitals, the companies have slashed the amount offered as payment for treatment of policy holders and are offering rates that are 50 percent less than the rates currently prevailing in the city," said Dr Divyang Brahmbhatt, an eye surgeon who runs a private eye hospital.
This cost-cutting would deprive the policy holders of a choice of doctors and hospitals, Brahmbhatt said. He added that the policy holders will not be able to avail of the advanced facilities offered by hospitals and doctors who had not signed the new MoU with the TRPs and the government-run insurance firms.
The city's medical fraternity, including corporate hospitals and private practitioners offering their services at hospitals, unanimously decided on Friday to boycott the new terms of cashless mediclaim MoUs. Ahmedabad medical association (AMA) vice-president, Dr. Pragnesh Vachhrajani, said that AMA had decided not to accept the new terms and has alerted the entire medical fraternity not to sign MoUs with the government-run insurance companies.
"We have also asked physicians to cancel, before March 31, the MoUs they had signed with the insurance firms before the AMA resolution was passed on Friday," Vachhrajani said.
According to the hospitals and doctors, the most unacceptable terms of the MoUs for cashless mediclaim are part-payment of claims, and the cost-cutting that limits the choice of policy holders as well as that of doctors. "When doctors had no say in deciding the premium a policy holder should pay for a particular insurance policy, how can the government-managed insurance firms ask the doctors to treat the patients at a particular rate?" said Dr Vikram Shah of Shalby Hospitals.
Shah further said that the companies have quoted rates which are 35 to 40 less than what they have quoted in MoUs offered to hospitals and doctors in Delhi and Mumbai. "But the policy holders pay premium at the same high rate whether they are treated in Delhi, Mumbai or Ahmedabad," he said.
The list of fixed rates for different illnesses and treatment fixes Rs18,000 as the rate for cataract surgery when the treatment actually costs Rs25-35,000 in Ahmedabad. Similarly, it has fixed Rs23,000 for gall bladder surgery which actually costs around Rs85,000 in the city. For a hernia operation, the insurance companies have quoted Rs12,000 while its actual cost is around Rs65,000.
Similarly, for knee replacements, the government-run insurance companies have fixed Rs1 lakh as treatment cost but the actual cost of treatment is more than Rs2 lakh. Rs10,000 has been fixed as the cost for 5-day hospitalisation for typhoid, jaundice or malaria while the actual cost for this comes to Rs30-35,000, depending on the severity of the infection, the hospitals say.
Doctors in the city say irrational cost-cutting would hamper the upgrading of healthcare services and hospitals. Hospitals and doctors would be forced to offer patient services of lower quality.
Prof (Dr) KV Ramani of the Indian Institute of Management-Ahmedabad's centre for management of health services, said that due to extreme cost-cutting proposed by the government-run insurance companies, there is a lot of resistance among the medical fraternity towards the new terms offered by their MoU. There are also graver concerns like limiting patients' choice to particular providers, he added.
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