Page 34 - Forbes - India (January 2020)

Pre-Budget sPecial

not-for-profit body that represents the “if the aVerage indian can sPend `500
majority of health care providers in
India, wrote a letter to the authorities on a digital Plan for their Phones, an
requesting for a revision in package aMount siMilar to it [towards insurance]
rates. The letter noted that the prices is well worth it for good health.”
were “unscientific” and “insufficient”.
Prices have since been revised; the Suneeta reddy, Managing director, apollo hospitals Group
government brought on board the
Post Graduate Institute of Medical
Education and Research, Chandigarh `1 lakh cost of the treatment. “I them her card at the counter after the
to come up with more suitable rates. didn’t have to pay anything,” he surgery, they checked their computer
But private players are still unhappy. says. He just had to show his sister’s and said I will only get `10,000 now,”
card and medical file at the AB- says Amir. Tasneem winces in pain
o combat Tasneem’s liver cancer, PMJAY counter at the hospital; the as he speaks, pressing her forearm
doctors at the Tata Memorial authorities keyed the data into their to her upper-right abdomen, just
t Hospital first gave her transarterial computers and gave the Sayeds the under her ribs. “I feel a shooting
chemoembolisation (TACE) injections benefit of cashless treatment. pain on and off,” she says softly.
thrice, at weekly intervals. The Often, surgery can be avoided after Amir managed to get the balance
injections helped destroy some of TACE injections, but in Tasneem’s amount from a trust that specifically
the cancer cells and also reduced case, it was necessary. She was helps patients from Bihar, but the
the supply of blood to the tumour, successfully operated upon, but this expenses are spiralling. “The hospital
starving it of the nutrients it needs time the `1 lakh-plus bill that was stay, the tests, drugs, transportation,
to grow. “The injections helped clocked up could not be covered by it’s all adding up,” says Amir. “They
shrink the tumour,” says Amir. AB-PMJAY because the package say it’s a `5 lakh cover, but you don’t
AB-PMJAY covered the entire amount was exhausted. “I showed get that amount. I understand they
34 have their limits per treatment, but
What does it entail? Successes so far her treatment is not yet done.”
`5 lakh rofit margins of listed hospital
medical cover per family per year 71.7 lakh chains are 15 percent to 20
patients treated p percent at best. If the discount
3 days of pre- and 15 days of post- between our prices [for medical
hospitalisation expenses are included treatments] and Ayushman Bharat’s
Treatments worth
Covers 1393 secondary and tertiary care `10,312 crore listed prices is more than 15 percent,
we’ll go at a loss,” says the chairman
procedures provided of a top hospital chain that has
Who is eligible? 19,985 chosen not to be part of AB-PMJAY.
He breaks down the economics of
10.74 crore hospitals empanneled of which more a hospital: Say the cost of a surgical
than half are private
families procedure is `100. Doctor fees, direct

or roughly 50 crore people who make up consumables and medicines cost about
`50 on average. Thereafter around
the bottom 40 percent of population as
per SECC 2011 data `35 gets consumed by other costs such
33 states and as staff salaries, administration costs,
No cap on family size or age Union Territories electricity, power, stationary etc. That
implementing the leaves an operating profit of `15.
How is it funded? scheme repayments are made from the
“Your interest and loan
iNfographics: sameer pawar Annual estimated cost basis a premium West Bengal are `15; what’s left thereafter is your
Delhi, Odisha,
`12,000 crore
Telangana and
cash flow. That is the construct of a
not on board
of `1100
hospital business,” he says dryly.
“Now if the market price is
Cost to be shared by the Centre and
Claims totalling `8872.5 crore approved
`100, the Ayushman Bharat price is
states in a 60:40 ratio
forbes india • january 31, 2020 Source AB-PMJAY data for 15 months ended Dec 2019 close to `30. But let’s say, it’s `50.