admin
Morning Health Talk :
New Delhi, June 28, 2018 :
Can the Govt. force hospitals & doctors to comply with the price capping under the Ayushman Bharat National Health Protection Scheme?
When we talk of affordable health care, we need to have value for money for both masses as well as classes. The economically weaker section of the society or BPL with more than 40 categories are today deprived of secondary and tertiary health care.
Without insurance, it is not possible for a citizen to afford secondary and/or tertiary health care. Workers drawing a salary of up to Rs 21,000/- a month are mandatorily covered under ESI. Those who have a salary of more than Rs 21,000/- should pay the private insurance premium on their own. Then there is a subgroup of people in this income bracket, the EWS and BPL, who cannot even afford any insurance premium.
The responsibility falls on the state to provide health care to all under Article 21, “No person shall be deprived of his life or personal liberty except according to procedure established by law”.
The Ayushman Bharat National Health Protection Scheme, therefore, can be a way to bridge this gap. The scheme principally targets the poorest and the vulnerable sections of the society. It will cover more than 10 crore poor and vulnerable families (approximately 50 crore beneficiaries) providing coverage upto 5 lakh rupees per family per year for secondary and tertiary care hospitalization with no restriction of family size. This coverage of Rs 5 lakh for the whole family for the economically backward patient may be sufficient in 80-90% cases.
The experience of the National insurance companies has been that reimbursement has been more than the total premium collected, so they were forced to bring in TPA to cap the prices of reimbursement which has been practically accepted by the medical establishment.
The Govt has fixed the pricing for 1,354 treatment packages under the Ayushman Bharat National Health Protection Scheme. More than 20 specialties like cardiology, cancer care, neurosurgery and neonatal care have been covered under the scheme depending on the type of therapeutic category and procedure. These package rates include all the costs associated with treatment i.e. the govt. has capped the total money required for the treatment.
Without invoking the Essential Commodities Act, the govt. cannot cap the prices but they can cap the prices for enrolling the medical establishment under their loop or at the most, the govt. can provide the list of hospitals as preferred hospitals as is the prevailing practice in third party reimbursements.
Participating in the scheme is voluntary; the hospital may or may not choose to join. Success of the scheme will depend on how many will enroll in the scheme. If the participation is poor, the govt. will be forced to revise the reimbursement charges. But, if the scheme gets off successfully, then the govt. may continue with the present reimbursement rates.
But everybody needs to work with the govt. and not compare the rates of the Ayushman Bharat National Health Protection Scheme with those of CGHS, PSUs, TPAs as they are not meant for the EWS/BPL patients but for rich patients.
Charity has to be at the cost of the rich. Therefore, the govt. may consider subsidizing the cost of poor by way of subsidizing package in Ayushman Bharat National Health Protection Scheme by revisiting the rates of package for non Ayushman Bharat subsidized people who are not in the income bracket of this scheme.
Polio can come back any time
SYDNEY (AFP) – An outbreak of polio has been confirmed in Papua New Guinea as per WHO with the virus detected in a child, 18 years after the Pacific nation was declared free of the disease.
The WHO said there was one confirmed case – a six-year-old boy with lower limb weakness from Morobe province – with the disease detected in late April, and paralysis associated with the virus confirmed in May.
The US Centres for Disease Control and Prevention said the same virus was also isolated from stool specimens of two healthy children in the same community, “representing an outbreak”.
According to the WHO, the number of polio cases worldwide has fallen by more than 99 per cent since 1988, from an estimated 350,000 cases then to 22 reported cases in 2017.
Only three countries – Afghanistan, Nigeria and Pakistan – were considered polio-endemic by the WHO in March.
Coke and Pepsi to reduce their sugar content in Australia: Will they follow it in India?
SYDNEY (REUTERS) – Australia’s biggest soft drink makers, including Coca-Cola and Pepsi, pledged on Monday (June 25) to cut industry-wide sugar use by a fifth over seven years to curb obesity in a country where nearly a third of the population is dangerously fat.
Companies will aim for a 10 per cent reduction in total sugar per 100 millilitres in their drinks by 2020 and a 20 per cent reduction by 2025, achieved via a combination of recipe modification and increasing sales of low-sugar beverages.
The WHO said last year drinking fewer sweet drinks was the best way to curb excessive weight and prevent chronic diseases such as diabetes, although fat and salt in processed foods were also to blame.
Canagliflozin Safe
The drug was not associated with an increased risk for below-knee amputations in an observational study of more than 700,000 patients with type 2 diabetes in the OBSERVE-4D study (Canagliflozin vs Other Antihyperglycemic Agents on the Risk of Below-Knee Amputation for Patients with T2DM — A Real-World Analysis of >700,000 US Patients) presented as a late-breaking poster on June 25 here at the American Diabetes Association (ADA) 2018 Scientific Sessions by John B. Buse, MD, PhD, director of the Diabetes Center at the University of North Carolina School of Medicine in Chapel Hill.
Dr KK Aggarwal
Padma Shri Awardee
Vice President CMAAO
President HCFI
HealthySoch
