IMA Chennai flags flaws in health insurance reforms proposed by IRDAI

Nov 09,2023

Chennai: The state unit of the Indian Medical Association expressed reservations about the proposed reforms by the Insurance Regulatory and Development Authority for 100 per cent cashless health insurance.

On Monday,  IMA state president Dr T Senthamil Pari said policyholders would be forced to go to “empanelled network hospitals”. This will curtail their right to choose their doctor and hospital. “During emergencies, they will be constrained to search for network hospitals and lose out on the ‘golden hour’. Patients should have the freedom to choose healthcare providers based on quality rather than be restricted to those accepting cashless package rates,” he said. It would also prevent hospitals outside the empanelled list from serving patients.

Packages, he said, would mean end-to-end prefixed cost from consultation, diagnostics, and in-patient treatment including for surgical procedures and medicines.

These rates will affect quality healthcare services too, doctors said. “The prevailing low unscientific package rates fixed by insurance companies hinder the optimal usage of resources, utilization of advanced technology and, in turn, affects patients care,” said IMA state secretary Dr N R T R Thiagarajan. The government through regulatory guidelines and acts (Clinical Establishment Act 2010, Minimum Wages Act and IPH standards) has framed guidelines for establishing and running a hospital, and has also suggested treatment guidelines for various diseases. “The rates fixed by the insurance company for the package makes it unsustainable for hospitals to follow the guidelines. It may compromise quality,” he said.

Besides bringing back reimbursement modules, the government must consult experts to develop a scientific health care costing template and ensure yearly revisions. Doctors also wanted awareness programmes for policyholders.

Source: HealthWorld