Uniform rates in pvt hospitals across all states an uphill task, as majority do not implement CEA: Health ministry

New Delhi: With as many as 16 states failing to implement the Clinical Establishments (Registration and Regulation) Act, 2010, the Central government has come up with a pricing template for all states. However, the states have expressed their concern that fixing a price range may not be feasible, according to the Union health ministry.

In a 37-page affidavit filed in the Supreme Court on Monday, a copy of which has been seen by Mint, the ministry said that many of the states have their own health schemes while many peopleare covered under the Ayushman Bharat scheme.

Glaring discrepancy

The apex court had earlier asked the ministry to hold a meeting with all the state health departments after finding glaring discrepancy in the prices of medical treatments across government and private medical facilities. 

The Court had, in February, strongly criticized the Centre’s failure to enforce the 14-year-old Clinical Establishment (Central Government) Rules, which are aimed at enforcing standard charges for various medical treatments and procedures.

Also read: Health ministry expands scheme for pregnant women

"One size fit approach may not be feasible. This seems to be an uphill task for recommendation of rates," the ministry stated in its affidavit.

After the Supreme Court's direction in February, the health \ministry called for a virtual meeting with states which was chaired by the Secretary Apurva Chander in March. Currently only 12 states and seven UTs have implemented the Clinical Establishments (Registration and Regulation) Act, 2010.

It has not been adopted by 16 states -- Andhra Pradesh, Chhattisgarh, Goa, Gujarat, Karnataka, Kerala, Madhya Pradesh, Maharashtra, Manipur, Meghalaya, Nagaland, Odisha, Punjab, Tamil Nadu, Tripura and West Bengal.

Serious compromise

States like Gujarat and Madhya Pradesh had said that any rate range fixation may lead to serious compromise of quality healthcare and patient treatment, particularly in the private sector and it may decrease the level of healthcare. Uttar Pradesh also emphasized the fixation of the rates may lead to serious issues like rendering healthcare setups financially unviable.

Also read: Private hospitals on foreign forays may get a helping hand

Uttarakhand opined that the fixation of rates may render healthcare sector uncompetitive considering the economic dynamics and interaction of market forces. Bihar and Mizoram suggested that organizations like the IMA may be involved in this process of such discussions.

States such as Madhya Pradesh, Andhra Pradesh, TN and Delhi invited guidance/collaboration of MoHFW in this regard to proceed forward. West Bengal informed that majority population are covered by the state act for quality and affordable access of healthcare by state schemes thereby they do not intend for fixation of rates.

Readied template

Only the states and UTs where the clinical establishments act 2010 is applicable—Uttar Pradesh, Bihar, Himachal Pradesh, Telangana, Uttarakhand, Andaman and Nicobar, Mizoram showed willingness for rounds of discussions with stakeholders and invited the guidance/collaboration of MoHFW in this regard to proceed forward.

The Health Ministry has come up with a 'Template of Costing of Procedures' which have been prepared by the DGHS and approved by the National Council for Clinical Establishments (NCCE) to all the states/UTs with a suggestion that it may be used as a baseline framework to work out the cost of medical procedure and services applicable in the states/UT, by due consideration of various local factors such as location of clinical establishment, type of clinical establishments, treatment/healthcare personnel qualification and experience etc.

Also read: Not just Asia, but world can adopt Ayushman Bharat scheme: UNDP India Health Head

The medical bodies, hospital associations expressed their satisfaction with hearing. Harish Salve, Senior Advocate appearing for NATHEALTH - Healthcare Federation of India in this case said to Mint that it is not for the Courts to determine the price of medical services, it is the duty of the legislature. "No mandamus can be issued to the Government in this regard. Price fixation of medical services, for all hospitals, all across India is not possible. No one size can fit all. There is no comparison between a government hospital which receives various subsidies from the government and private hospitals, who are not beneficiaries to any such subsidies. No other service industry in India is price capped as the same is not possible," he stated.

“We appreciate the observations in proceedings yesterday that standardizing rates of treatment packages will have significant implications on the quality of healthcare services, patient safety, treatment outcomes, sustainability, and the continued investment required to meet unfulfilled infrastructure and clinical capacity expansion towards healthcare for all agenda. The Government's remarks also highlighted these concerns," said Abhay Soi, President, NATHEALTH.