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Ayushman Bharat impact! Private hospitals miffed over lower rates for cancer care

The new package rates finalised about a month ago are now up on the Ayushman Bharat website. Some private hospitals do not find the rates viable

twitter-logo E Kumar Sharma        Last Updated: November 26, 2019  | 14:53 IST
Ayushman Bharat impact! Private hospitals miffed over lower rates for cancer care

The team driving Ayushman Bharat, the Modi government's flagship health cover programme, has a lot of work cut out for it over the next six months. Indu Bhushan, CEO of Ayushman Bharat, says: "We are finalising standard treatment guidelines and working on how to migrate IT systems accordingly. It will ensure compliance with guidelines."

On capacity building, he says, "we are trying to identify agencies with networks of doctors for seeking advice on treatment protocol. Many hospitals have their own tumour boards but at a national level with the help of National Cancer Grid (network of major cancer centres, research institutes, patient groups and charitable institutions), we will empanel doctors who can review cases and give treatment advice.

There will be fees for this. The new package rates finalised about a month ago are now up on the Ayushman Bharat website. Some private hospitals do not find the rates viable. "The revised rates are not unviable and are based on feedback from people. There is a fundamental shift now as rates are linked to the drug regimen prescribed to the patient," Bhushan says.

But private players are not convinced. Some argue the revised rates are unviable and sharply lower. In oesophagectomy, the revised rate is down to Rs 28,300 from Rs 75,000. In abdominal wall tumour resection, the revised rate is Rs 25,000 against Rs 35,000 earlier. In anterior resection of rectum, it is down to Rs 28,500 from Rs 70,000.

Bhushan says a lot of work has been done with Tata Memorial Hospital and the National Cancer Grid. He says, "Now we are expanding coverage under cancer care and realise that cancer care will be one of the major public health issues in future. We want to ensure people get quality services."

According to a working paper on oncology trends put out by Ayushman Bharat, oncology comprised nine per cent of claims submitted, and 34 per cent of all tertiary claims submitted till date across 26 States/UTs. Two States (Tamil Nadu and Maharashtra) generated 60 per cent of all oncology claims. The primary type of Oncology service included Medical oncology, except in Manipur. Top hospital catering claims under oncology are Tata Memorial Hospital and Research Centre, Maharashtra followed by Govt. Super Specialty Radiology, Omandur, Tamil Nadu. Overall, more than 7 out of 10 claims submitted for oncology were in the private sector, except in Andaman and Nicobar Islands, Arunachal Pradesh, Chandigarh, Kerala, Mizoram and Sikkim generating no oncology claims at private hospitals.

Women accounted for higher number of claims submission in all age-categories. The top category of procedures utilised for oncology services is unspecified regimen. Ovary, Breast, Cervix and Radical hysterectomy are some of the common cancer types among females; and Terminally Ill palliative, Colon Rectum and head and neck cancers are among males for which maximum claims are generated during the period. So far, about 1.36 lakh cancer patients have taken treatment through 4.12 lakh pre-authorisations (or total claims) in the scheme. This is out of 57 lakh pre-authorisations. Bhushan says, out of 18,000 hospitals (both public and private), close to 1000 are in cancer care.

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