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That private hospitals, though only in Hyderabad, have decided to resume from Thursday services for Aarogyasri beneficiaries needing angioplasties is...

That private hospitals, though only in Hyderabad, have decided to resume from Thursday services for Aarogyasri beneficiaries needing angioplasties is welcome news. They had, across Andhra Pradesh, stopped performing the procedure from August 15. The health scheme had been conceived for such poor persons as could not pay for their treatment of ordinary ailments or heart trouble.

According to a conservative estimate, at least 300 angioplasties are needed to be performed in the State every day. Yet private hospitals stopped performing them, demanding that the State government increase the recently slashed tariff. The tariff was slashed from Rs. 60,000 to Rs. 40,000 by the Aarogyasri Trust in June, ostensibly to check exploitation. This reduction in payment reportedly resulted from the view that most of the angioplasties were performed even when they were not required. If there indeed was such a malpractice, the Trust should have investigated such cases and taken action against the errant hospitals. Instead, by reducing the tariff across the board, the Trust has only deprived the poor of essential medical attention.

On their part, private hospitals should have realized that they could not expect the poor to pay, or the Trust to pay on their behalf, what others could and did. Of course, private hospitals are not run for charity; but was it not heartless to expect the poor to pay what the middle class and the rich could? State-run hospitals are yet to inspire confidence among the poor to make them flock to them for treatment, either free or for a nominal charge. It is also true that even the poor beg, borrow or steal to have themselves treated in private hospitals even though not every private hospital deserves that respect. Nobody can deny that there are many private hospitals throughout Andhra Pradesh, even in Hyderabad, whose medical staff is not exactly qualified.

Yet the irrational belief persists that, for whatever illness, they should go only to a private hospital. It was essentially that belief that emboldened private hospitals to refuse to perform angioplasties on those covered by the Aarogyasri scheme. The AP Chapter of the Cardiological Society of India (CSI) had served an ultimatum on the State government that unless the tariff was hiked by 30% from the “pre-revised package” of Rs. 60,000, heart surgeons would not relent.
What neither side seems to realize is that in this cross-fire it is the poor who are suffering. The CSI may well be right in arguing that doing any procedure with a tariff below Rs. 1 lakh is “not remunerative”; and that the recently evolved tariff package of Rs. 40,000 is “woefully inadequate to cover the costs of the materials used in hospitals.” The tariff reduction, according to the CSI, has forced “hospitals to opt for cheaper alternatives which may worsen rather than cure heart diseases”.
Out of the 74 hospitals carrying out cardiac procedures under the Aarogyasri scheme, about six are State run, and even they supported the demand of the private hospitals! In Government hospitals, 20% of the amount goes to the hospital development society and the rest for the purchase of disposables and consumables and the department, with one-third going to the hospital. Experts, however, argue that even when they were being paid Rs. 60,000 per procedure, private hospitals used inferior materials to increase their profit margin. Anyway, people will hope that the committee that the Trust is to set up to study the problem of tariff will suggest a way out.
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