more-in Mumbai: The National Health Protection Scheme (NHPS), the Central government’s bid to provide medical insurance to 10 crore families, may not have a perfect start: doctors are unhappy with it, and only 10 States may actually roll it out on August 15, its launch date. The scheme, also called Ayushman Bharat and, unofficially, Modicare, offers 1,350 packages for medical problems ranging from heart ailment to joint replacement. Each family under this scheme will get an annual insurance cover of ?5 lakh. This, say experts, will overlap with schemes already being provided by States like Maharashtra, Tamil Nadu, Kerala and Andhra Pradesh. Maharashtra, for example, offers insurance cover of ?1.5 lakh to the economically challenged. Besides overlapping with existing schemes, NHPS would mostly be dependent on public sector hospitals, as the low package rates may keep the private sector away. In fact, some State governments, including Maharashtra and Rajasthan, have shown reluctance as well. Chief Minister Devendra Fadnavis, who is yet to sign the Memorandum of Understanding (MoU) with the Centre for the scheme, said, “We’re looking to merge positive aspects of both schemes to ensure wider reach and more beneficiaries.” Sources in the State government say the reluctance stems from lack of clarity on how to merge the schemes. There is also a fear that overlapping will create unnecessary confusion for hospitals, insurance companies and beneficiaries. The Indian Medical Association, the country’s largest doctors’ body with over 2.5 lakh members, had wanted the Central government to reconceive the scheme. Last week, the IMA changed its stance, and has entered into an agreement as a NHPS partner. Dr. Ravi Wankhedkar. president, IMA, said, “The government agreed with us on various points and made changes.” Flawed model Doctors, who will be the scheme’s backbone, have objections. Dr. Wankhedkar, a Dhule-based surgeon, said, “We had suggested to the government that insurance companies and Third Party Administrators be kept out, and the service be directly purchased from healthcare providers. Insurance companies will get profits between 17% and 32%. If the scheme is mostly implemented by the public sector, why should the government pay to hospitals it runs through insurance companies?” In the U.S., he added, the insurance model has failed, while the U.K.’s National Health Service is doing well as the government pays the healthcare provider. “The only incentive for insurance companies is profit. These intermediaries siphon off 40% of the budget and are breeders of corruption and unethical practices.” While the insurance model remains, certification from the National Accreditation Board for Hospitals and Healthcare Providers won’t be needed for hospitals to empanel themselves. This means medical setups with a minimum of 10 beds can be empanelled. ‘Rates too low’ Healthcare providers say the package rates proposed are abysmally low, and don’t cover even 30% of the cost incurred. The IMA, too, has expressed unhappiness. To address their concerns, the Central government has set up a committee to review and rework rates. For example, a cemented total hip replacement is capped at ?75,000 and a cementless one at ?90,000, while a Caesarean sections won’t cost more than ?9,000. For heart ailments such as a coronary artery bypass surgery, the cap is ?90,000, angioplasty with one drug eluting stent at ?50,000 and with two stents at ?65,000. Dr. Prince Surana, director, Surana Group of Hospitals, said, “Medicines required in a bypass surgery cost nearly ?45,000, and consumables around ?60,000. It needs a team of at least four people, including the surgeon and an anaesthetist. The patient needs to be hospitalised for at least 10 days. How will a price cap of ?90,000 cover all this?” Dr. Surana, who has decided to drop out of the State government’s insurance scheme, said it offers a cover of ?1.3 lakh for bypass on a beating heart, and ?1.5 lakh when a special balloon pump is used.. “The rates in the State scheme have been the same for the past four years. They have not covered inflation at all. I don’t think the new national scheme will be any different.” He said NHPS may not work in big cities, but will find takers in tier-II and tier-III ones, as the package rates may suit healthcare providers there. IMA member Dr. Jayesh Lele, a city-based general physician, said quality will suffer if the package rates are low. “Doctors will be in danger because the scheme will prepare the ground for violence against them.” Charitable trusts with deep pockets and corporatised hospitals are maintaining silence. “Since it is not compulsory, we have decided to wait and watch. At the current rates, there is no way hospitals like ours can be empanelled,” a doctor attached to a top private hospital in the city said. With only one or two members of the Association of Hospitals, comprising 52 private city hospitals, empanelled with the State health insurance scheme, it’s unlikely that Modicare will fare better with them, experts said.

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