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Morning Health Talk :
New Delhi,July 09, 2018 :
Ayushman Bharat : Will cross subsidy be the answer?
Ayushman Bharat is National Health Protection Scheme by the government for 40 crore people who are from BPL or EWS category. These otherwise either are non-insured or were covered in the previous RSBY scheme.
The rates provided for LSCS (caesarean section) are 9000/-.
The medical profession says our cost is 57000/-
Then what is the answer. Will cross subsidy be the answer?
Cross subsidization is the practice of charging higher prices to one group of consumers to subsidize lower prices for another group.
Suppose Mr X goes to dinner with two of his friends Y and Z. X’s meal costs 100/-, Y’s meal costs 200/- and z’s meal costs 300/-. The total bill is then 600/- and everyone decides to split the bill evenly, for 200/- each. X’s meal is under costed. Z’s cross-subsidizes Alex for 100/-. Y is neither cross-subsidized nor cross-subsidizes anyone else.
TN-IMA has shown that the real cost of a caesarean in private sector is 57515/- (say 57000 for calculations) for 50 bedded hospital with 50% occupancy. The rates will be lower if the occupancy is 90%.
In Ayushman Bharat the government proposes to pay 9000/- for basic hospital (10% extra can be given by states, 10% extra for entry level NABH, 15% extra for NABH accredited and 10% extra for DNB- MD teaching hospitals, setups in rural areas 10% extra).
Even if it comes to 12000, the establishment will have to provide a subsidy of 45000/- Rs.
How will the establishment cover the cost?
Ayushman Bharat covers 40% of the population
- The government should give 40% concession in taxes to such establishments (property tax, income tax, service tax, land at concessional rates where applicable etc)
- All hospitals who are given concessional lands instead of free services can be asked to register under the Ayushman Bharat
- Or the rich must provide the cross-subsidy to the poor. The package rates of the rest 60% should be higher than the derived prise. CGHS, PSU and insurance rates needs to be revised accordingly.
Typically, a hospital run in three tier system: single room (fully private), three bedded shared (semi private) and general economy ward. Cost of a procedure is 100 Rs for private, 60 Rs for semi private and 30% for the general ward. 10-20% of the beds are reserved for the general ward.
CGHS rates are applicable to the single room also. Even the ministers will be charged the same rates. The charges for BPL or ESW thus has to be lower than that.
Note: The above is just one example and a concept. The actual prises will vary with the average cost derived when all procedures are included.
For example, The Centre has included 1,354 packages in which treatment for coronary bypass, knee replacements and stenting, among others, would be provided at 15-20% cheaper rates than the Central Government Health Scheme. Stenting at Rs 40,000, coronary artery bypass grafting at Rs 1.10 lakh, vertebral angioplasty with single stent at Rs 50,000.
Some of the other rates are Knee and hip replacements Rs 9,000 each, caesarean delivery at Rs 9,000 and hysterectomy for cancer at 50,000.
There is no rationalisation of the rates. Cardiology reimbursement and caesarean reimbursement are not rational.
Dengue epidemic in SHIMLA and CUTTAK
With the onset of monsoon season, the hill state of Himachal Pradesh is witnessing the rise in a number of dengue cases (96 confirmed cases) with most of the cases being reported from Bilaspur district.
Cuttak: Dengue 46 confirmed patients are coming to SCB from Jajpur, Kendrapara, Bhadrak, Balasore, Keonjhar, Nayagarh, Khurda, Cuttack and Puri districts.
Salt reduction
Dietary sodium reduction can lower BP in both hypertensive and normotensive individuals, prevent hypertension, and enhance the BP response to most antihypertensive therapies. The
extent of BP reduction because of reduced sodium intake is greater in blacks, middle- and older-aged persons, individuals with hypertension, and, likely, patients with diabetes or kidney disease.
In hypertensive individuals reduce dietary sodium intake to <2.3 g of sodium or 6 g of salt /day (lower the better). In persons without hypertension also reduce dietary sodium intake to the same level with the goal of preventing hypertension and decreasing the risk of stroke and other cardiovascular events.
Dr KK Aggarwal
Padma Shri Awardee
Vice President CMAAO
President HCFI
HealthySoch
