Panel finds private hospitals’ proposal on COVID-19 treatment cost for scheme patients ‘affordable’

The cost of COVID-19 treatment for asymptomatic patients from the below poverty line (BPL) families is likely to be fixed at ₹5,200 a day under the Ayushman Bharat Arogya Karnataka (AB-ArK) health insurance scheme.

This rate — which is part of a proposal submitted by the Federation of Healthcare Associations of Karnataka (FHA-K) to the government — has been recommended as “reasonable” by an eight-member committee set up by the government on June 4 to do a costing study of COVID-19 treatment in private hospitals.

FHA-K proposal for COVID treatment

  • General ward: ₹5,200 for Ayushman Bharat Arogya Karnataka (AB-ArK) patients and ₹15,000 for other insurance and cash patients
  • Ward with oxygen: ₹7,000 for AB-ArK and ₹20,000 for other insurance and cash patients
  • Isolation ICU: ₹8,500 for AB-ArK and ₹25,000 for other insurance and cash patients
  • Isolation ICU with ventilator: ₹10,000 for AB-ArK and ₹35,000 for other insurance and cash patients

The committee, however, has recommended that the ceiling of the rates proposed for non AB-ArK patients (cash and private insurance patients) should be slashed by 20%.

The FHA-K, jointly with the Private Hospitals and Nursing Homes Association (PHANA) and the State unit of the Association of Healthcare Providers of India (AHPI), had earlier this week submitted a costing proposal to the government both for those covered under the AB-ArK and other private insurance schemes and those paying cash.

‘Excludes COVID testing’

Nagendra Swamy S.C., FHA-K principal coordinator, said the proposal by private hospitals factors in the PPE cost and excludes COVID-19 testing. The COVID-19 test required prior to discharge costs ₹2,250 if the government pays it. Otherwise, it costs ₹4,500 in a private testing lab.

“The treatment cost has been proposed at ₹7,000 if the patient needs oxygen support in a ward, at ₹8,500 in an isolation ICU (without ventilator) and at ₹10,000 if admitted in the ICU with a ventilator. All these costs are inclusive of PPE and routine drugs and investigations,” Dr. Nagendra Swamy said.

“The number of days of hospitalisation will not be the same for every patient. Hence, we have fixed it on a daily basis. However, the price does not include the cost of treatment of comorbidities. High-end drugs and plasma therapy will be charged at actuals,” he said.

Similarly, for private insurance and cash paying patients, the treatment cost has been proposed at ₹15,000 in a general ward, ₹20,000 in a ward with oxygen support, ₹25,000 in an isolation ICU without a ventilator, and ₹35,000 in an ICU with a ventilator.

Sources said the committee headed by N.T. Abroo, executive director of the Suvarna Arogya Suraksha Trust (SAST), which implements the State’s health insurance schemes, met on Saturday and recommended that the price quoted by the FHA-K for AB-ArK patients is “reasonable” and hence can be “accepted” by the government.

“We studied the costing model adopted by Maharashtra, Tamil Nadu, Kerala, Andhra Pradesh, Telangana, and Punjab. The proposal by the FHA-K for AB-ArK patients is “acceptable” as it includes PPE and other consumables apart from bed charges and routine investigations. The committee unanimously agreed to recommend that the rates for AB-ArK patients can be accepted,” said a member of the committee.

“For non-AB-ArK patients, the ceiling should be slashed by at least 20% as the rates are higher when compared with that in other States,” the member said.

The proceedings of Saturday’s meeting will be sent to the government and placed before the COVID-19 Task Force that is scheduled to meet on Monday. A final decision will be taken after that, the member added.

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