Times of India
20 August 2010
By Manthan K Mehta
Mumbai, India

Clash Between Medical Fraternity & Public Sector Insurance Firms Continues As Top Hospitals Do Not Agree To New Rates
The battle between healthcare centres and public sector insurance companies is far from over, but on Thursday, 132 city hospitals have agreed to follow the Preferred Provider Network (PPN). This, despite the fact that many in the medical community have refused to retract their claims that the new rates for 42 procedures offered by the insurance companies under the cashless scheme are ridiculously low and it will be difficult to provide quality treatment under the existing terms and conditions.

Members of the Association of Medical Consultants (AMC) will be meeting with representatives of the Association of Hospitals (AOH) to discuss a common strategy to counter the insurance companies. Sudhir Naik, secretary of the AMC, said: “A joint front is necessary to ward off any pressure from insurance firms. Ultimately, patients are going to suffer if quality treatment cannot be provided at the new rates.” The AOH comprises 56 hospitals, including the elite Jaslok, Hinduja and Breach Candy Hospitals that are boycotting the cashless cover scheme. The AMC, which has 6,850 members in the Mumbai Metropolitan Region (MMR), told TOI that 50 hospitals have decided to opt out of the PPN.

Insurance companies, however, are unperturbed by the recent developments. An official from General Insurance (Public Sector Association) said, “Only a section of the medial fraternity is against the rate card or the PPN. More and more hospitals are accepting our rates despite calls by medical consultants to boycott cashless cover.” He added: “So far, 132 hospitals have joined the PPN in Mumbai. This shows that the opposition is limited to only a few healthcare centres. We are in the process of negotiating with more hospitals, and are confident that many will join the PPN in the coming days.”

The AMC, too, refuses to back down. Dr Naik said, “Large corporate hospitals from Mumbai have not joined the PPN.” Colonel Manesh Masand, CEO of Jaslok Hospital, who is negotiating with the PSUs said it was imperative to arrive at a solution. “We are involved in positive dialogue with the GIPSA, and will meet on August 30 with a new set of proposals. We do not want patients to suffer.”

Many are resigned to the fact that they have no option but to accept the new rates. An official from a leading hospital that has joined the PPN said, “Sooner or later, hospitals will have to join the network as the profit margin in this sector is minimal. The agreement is for a period of one year. Within this period, the pros and cons of the new system will become clear.”