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IMA and Hospital Board of India raise concerns over newly launched `Cashless Everywhere’ scheme

by AIP Online Bureau | Feb 13, 2024 | Eco/Invest/Demography, Health, Indian News | 0 comments

The `Cashless Everyehere’ initiative has been rolled out without adequately addressing the concerns raised by the Indian Medical Association and Hospital Board of India. There is an absence of clear guidelines and procedures governing the implementation of the programme, said AK Ravikumar, chairman of Indian Medical Association (IMA) and the Hospital Board of India(HBI)

New Delhi:

The Indian Medical Association (IMA) and the Hospital Board of India have cautioned  hospitals against accepting the Cashless Everywhere’ initiative, recently unveiled by the by the General Insurance Council, in its current format, highlighting the potential risks involved.

An advisory, jointly issued, by the Indian Medical Association (IMA) and the Hospital Board of India, on the implementation of the `Cashless Everywhere’ initiative, comes amidst concerns raised by the medical community regarding the lack of clarity and potential implications of the newly launched programme.

According to a press statement issued by AK Ravikumar, chairman of IMA HBIHORS, the `Cashless Everyehere’ initiative has been rolled out without adequately addressing the concerns raised by the IMA  and HBI.

One of the key issues highlighted in the advisory is the absence of clear guidelines and procedures governing the implementation of te programme, said the statement.

Earlier, the General Insurance Council(GI Council), the official body of general and health insurance companies had announced a drive aimed at making cashless hospitalisation available for policyholders even in non-empanelled hospitals since Feb 1.

Under the drive ‘Cashless Everywhere’, efforts will be made to ensure that policyholders can get treated in any hospital they choose with a cashless facility, subject to certain conditions, the council’s chairman Tapan Singhel, who is also MD & CEO, Bajaj Allianz General Insurance had said.

There are over 40,000 hospitals in the country, which can now offer cash-less facilities to all the health insurance policy holders of all general and health insurance companies , numbering over 30 crore, in the new system.

In case a policy holder needs hospitalisation in a non-empanelled hospital, he or she should inform the insurance companies 48 hours before it. There will also be the option of informing the insurance company within 48 hours of hospitalisation for emergency treatment.

While the initiative allows policyholders to seek treatment at any hospital that complies with the guidelines set forth by the IRDAI, there remains ambiguity surrounding the one –time temporary MOU between insurance companies and hospitals, pointed out the statement issued by IMA and HBA.

The lack of clarity regarding MOU, as well as the inclusion of packaged deals discounts, and freebies, has raised concerns among healthcare providers. The IMA HBI advisory  emphasises that packaged deals should not be mandatory requirements for hospitals participating in the Cashless Everywhere ‘programme.

Citing various court orders, the advisory by the Indian Medical Association (IMA) and the Hospital Board of India states that packaged deals, discounts and freebies are non-scientific, potentially compromising the quality of healthcare and unjustly impacting patients.

In light of these concerns, the IMA HBI has issued a series of recommendations for its members to ensure the sustainability of healthcare facilities and uphold the quality of patient care.

These recommendations include rejecting MOUs that include packaged deals, discounts, and freebies, and advocating for payment based solely on actual medical expenses.

Additionally, the advisory urged insurance companies to establish eligibility criteria for policyholders based on their sum assured, with any excess beyond actual medical expenses to be copaid by the policyholders.

The IMA HBI also suggested adopting minimum sustainable charges for healthcare services, scientifically determined based on government standards for hospitals located in Tier 2 cities.

 

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