State invokes five laws to cap high private hospital costs

Non-insured patients to be charged lowest package rates

In a first, the State government has capped treatment costs in private hospitals for people without medical insurance. For others, the capped prices will come into effect once they exhaust their medical cover. The decision comes after several patients with COVID-19 and other ailments highlighted the exorbitant cost of treatment at private hospitals.

The notification issued by principal secretary Dr. Pradeep Vyas on Thursday states that hospitals should charge the lowest rates for procedures as per their pacts with insurance companies. Hospitals without such tie-ups will have to adhere to the capped rates for over 170 procedures like general surgeries, neurosurgery, and cardiac, obstetric, gynaecology, ophthalmology, and orthopaedic operations. Angiography has been capped at ₹12,000, angioplasty with one stent at ₹1.20 lakh, dialysis at ₹2,500, and knee replacement at ₹1.60 lakh.

Tie-ups with insurers

Most hospitals in Mumbai, Pune, Navi Mumbai, Panvel and Thane are members of the General Insurers’ Public Sector Association under the preferred provider network and have fixed treatment package rates worked out based on the type of hospital, infrastructure, and facilities. Other hospitals in the State have agreements with third party administrators under which treatment package rates are fixed.

Dr. Sudhakar Shinde, CEO of Mahatma Jyotiba Phule Jan Arogya Yojana, said, “As per the notification, if a non-insured patient visits any of these hospitals, he or she should be charged as per their lowest treatment packages, irrespective of whether the patient is admitted in a general or deluxe category.”

Dr. Shinde said hospitals now cannot levy charges as per their rack rates after patients exhaust their medical cover. He said the notification has invoked the Epidemic Diseases Act, the Disaster Management Act, the Maharashtra Essential Services Maintenance Act, the Mumbai Nursing Homes Registration Act and the Bombay Public Trusts Act. “We are in difficult times now and have urged all hospitals to comply with these norms,” he said.

The notification also states that hospitals should not charge more than a 10% markup on net procurement costs incurred on personal protective equipment, consumables, pacemakers, stents, and medical implants.

‘Under financial strain’

The CEO of a Mumbai hospital said the price cap will make it difficult for private hospitals to sustain themselves. He said, “We are already struggling with staff being quarantined after being exposed to COVID-19 patients. There is the additional burden of testing staff, arranging their transport during the lockdown, and paying their salaries even when they are off duty in quarantine. Hospitals are already facing many losses.”

Mum on COVID-19 costs

The notification, however, does not elaborate on capping the cost of COVID-19 treatment. While the Brihanmumbai Municipal Corporation has capped the rates of isolation beds at ₹3,000, the bills of many COVID-19 patients have crossed ₹5 lakh. Health minister Rajesh Tope said some hospitals have charged patients ₹1 lakh for a day of treatment. He said the notification will help prevent hospitals from charging exorbitant rates.

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