`We, direct the Secretary, Department of Health, Union of India to hold a meeting with his counterparts in the State Governments/Union Territories and come with a concrete proposal by the next date of hearing((in the next six week).In the event the central government does not come out with a concrete proposal by the next date of hearing, we will consider issuing appropriate directions in this regard,’’ ruled a Supreme Court bench of Justices B.R. Gavai and Sandeep Mehta
Tapan Singhel, chairman, General Insurance Council said, “It is very encouraging to see the Apex court urging the Centre to take a decision on standard hospital rates”
New Delhi:
In a development, cheering the Indian general insurance industry, the Supreme Court(SC), on Feb 27, has directed the central government to expeditiously fix the hospital treatment charges, which lack uniformity across the country, to be paid by patients, in the next six weeks.
“We, direct the Secretary, Department of Health, Union of India to hold a meeting with his counterparts in the State Governments/Union Territories and come with a concrete proposal by the next date of hearing((in the next six week),’’ said a two-judge division bench of the Supreme Court while hearing a public interest litigation (PIL) filed by an NGO.
“In the event the central government does not come out with a concrete proposal by the next date of hearing, we will consider issuing appropriate directions in this regard,’’ ruled a bench of Justices B.R. Gavai and Sandeep Mehta. .
A bench comprising Justices B.R. Gavai and Sandeep Mehta was hearing a PIL filed by an NGO-Veteran s Forum for Transparency in Public Life, through its general secretary wing commander (Retd) Bishwanath Prasad Singh- praying for the SC’s direction to determine the rate of fee chargeable by hospitals, across the country, from the patients in terms of Rule 9 of the Clinical Establishment (Central Government) Rules, 2012 ( ‘the Rules of 2012’).
The NGO had submitted that the Central Government itself has notified the rates which are applicable to the CGHS(Central Government Health Scheme) empaneled hospitals and had suggested that till a solution is found the Central Government can always notify the said rates as an interim measure.
The NGO has provided an example that the cost of cataract surgery in a private can range from Rs 30,000 to Rs 1,40,000 per eye, whereas the rates in a government hospitals whereas the rates in a government hospital are up to Rs 10,000 per eye.
The government’s counsels informed the SC that the rules framed in Clinical Establishments (Registration and Regulation) Act, 2010 ( the Act of 2010’) has been adopted by 12 State Governments and 7 Union Territories and in view of the provisions of Rule 9 of the Rules, of 2012, the rates cannot be determined by the central government unless there is a response from the State Governments/Union Territories.
Rule 9 of the Clinical Establishment Rules 2012 mandates hospitals to display their service charges prominently and conform and conform to rate ranges set by the Centre, in consultation with state government.
The government counsels further submitted that though various communications have been addressed to the State Governments/Union Territories, there is no response and as such the rates could not be notified.
However, the bench responded that the Act of 2010 has been enacted with an avowed object of providing medical facilities to the citizens at an affordable prices.
“The Union of India cannot shirk away from its responsibility by merely stating that communication have been addressed to the State Governments/Union Territories and they are not responding,” said the bench.
The general insurance industry, where Health Portfolio almost contributes around Rs 1 lakh crore of premium, is now keenly watching the development and expect a positive outcome on the hospital charges.
The industry, which recently launched its scheme `Cashless Everywhere’, where a policyholder can receive treatments from any hospital in the country and not just from its own insurer’s empanelled hospitals, is facing issues, as hospitals, across the country, are not adopting standardised rates for providing similar treatments.
Tapan Singhel, chairman, General Insurance(GI) Council said, “The GI Council and the insurance industry at large have always looked to minimize friction for customers, especially at the time of claims, while simultaneously offering best-in-class products at reasonable rates. We recently launched the ‘Cashless Everywhere ‘ initiative after discussions and deliberations with all players in the ecosystem. We have always maintained that we need to charge an appropriate cost for customers, whether it’s at the time of taking out a policy or bearing certain expenses at the time of a claim. It is very encouraging to see the Apex court urging the Centre to take a decision on standard hospital rates. We feel that this, along with ‘`Cashless Everywhere’ will eventually benefit our citizens, for whom it’s a fundamental right to receive good healthcare.”
However, 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.
There are over registered 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 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.
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.