NATHEALTH urges government to push for higher level of transparency by mandating hospitals to publish COVID-19 treatment charges

Also recommends appointment of Ombudsman at zonal level to inspect complaints of overcharging

NATHEALTH has submitted a representation on ‘COVID Package Pricing’ to Satyendar Kumar Jain, Health Minister, Government of NCT. In this joint representation, NATHEALTH has urged the government to continue to push for a higher level of transparency by mandating hospitals to publish their treatment charges. They have also recommended the appointment of Ombudsman at zonal level to inspect the complaints of overcharging.

The representation highlights the current unprecedented challenges being faced by the private healthcare providers in COVID treatment. Pricing is a factor of quality of infrastructure, level of services, medical protocol followed, brands of medicines used, skill and salaries of doctors and staff and more importantly the medical outcomes. In the view of COVID-19, the focus of treatment protocols has undergone a significant shift and the hospitals need to equally (if not more) ensure that healthcare workers (HCWs) are not infected, while treating patients and the hospitals themselves don’t become hotspots or super-spreaders. The new approach has thus led to an increase in the cost of care (both for COVID and non-COVID) and added to expenses.

Unlike the early days of the pandemic, hospitals are now admitting patients with significantly higher viral load, comorbidities and complications. Many of these high-risk patients need oxygen support and thus the impact on cost of care is expected to be higher than usual. At the same time, mild to moderate risk patients are being managed in extended COVID hospitals set up in hotels and at home. Based on their estimates, the incremental cost of care (beyond normal) is expected to be in the range of Rs 15,000-17,000 per day / patient. The focus of treatment protocols in COVID times has undergone a significant shift and the hospitals need to equally (if not more) ensure that healthcare workers are not infected while treating patients and the hospitals themselves don’t become hotspots / super-spreaders. This responsibility has thus led to increase in cost of care (both for COVID and non-COVID) and can be mainly attributed to:

• Additional staff due to shorter shifts, quarantine policy post roster duty, staff getting infected during treatment and impact of PPE’s etc. on the safety and health of HCW’s and their families. It thus takes 1.75-2.5 times of usual staff to treat COVID patients.
• Costs towards boarding, lodging and transportation of staff on duty and off duty, but under quarantine. This is necessary to protect families of HCW’s. In addition, free testing and treatment of HCW’s when infected, adds to the cost of operations.
• Cost towards personal protective equipment (PPE). As per FICCI study, 3-5 PPE is required per patient. Further, the price of common items like surgical mask has gone up by 80 per cent due to surge in demand.
• Free treatment being provided to patients from economic weaker sections
• Unviable Schedule of Charges: Hospitals are treating patients sponsored by the Central and State Government on CGHS 2014 tariff, which was valid till 2016. Similarly, the rates of public sector insurance companies (GIPSA) have not been revised since 2016, forcing hospitals to work on unviable prices for a large segment of patients. The hospitals end up cross-funding the losses from other patient segments.                                                                                
• Non-payment of PPE cost by CGHS and GIPSA
• Shallow penetration and coverage of insurance among general population exposing individual households to catastrophic expenditure for tertiary care.

Private hospitals within NATHEALTH – Healthcare Federation of India have jointly stated that, “We fully support the need for transparency of pricing to ensure that patients are not overcharged. Equally, there is a necessity of being viable, ensuring no compromise in the quality of care and more importantly no risk to healthcare professionals. The need of the hour is to embrace a collaborative approach, wherein, stakeholders work together to enhance the capacity and capability of the health system, to cater to the growing demand. Whilst the private health sector in Delhi continues to serve the community extensively and selflessly, it is, however, necessary that it survives to serve.”

As the number of COVID infections are expected to rise to 5.5 lakh in Delhi by end of the next month, there is a dire need to boost the infrastructure both in the private and public hospitals to handle the emerging crisis in the city. The private hospitals, so far, have been working shoulder to shoulder with the Government to develop protocol, improve testing, expand capacity, testing innovative solutions through clinical trials and also reducing the load on hospitals through remote monitoring and home management of mild risk cases. The private sector hopes that a collaborative approach will be adopted at such critical juncture where there is a dire need for all the stakeholders to work in unison to serve fellow countrymen.