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31 insurers, 26 TPAs seek to fix rates for surgical procedures

, TNN|
Nov 06, 2019, 11.34 AM IST
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Highlights

  • Insurers said that arbitrary pricing by private hospitals is hurting patients and insurers
  • The standardised pricing will also help patients as despite having insurance they have to bear some expenses out-of-pocket
(This story originally appeared in on Nov 06, 2019)
MUMBAI: In a bid to rationalise settlement of health claims, 31 general insurers and 26 third-party administrators (TPAs) have come together to fix rack rates for common surgical procedures such as cataract, hernia, appendicitis removal, kidney transplants, and angioplasty.

While hospitals will still need to agree to the recommended tariffs, general insurers are confident of pushing through standardised rates with most hospitals. The standardised pricing will also help patients as despite having insurance they have to bear some expenses out-of-pocket.

Insurers said that arbitrary pricing by private hospitals is hurting patients and insurers. A fairly common cataract operation results in bills varying from Rs 25,000 to Rs 3.5 lakh — depending on the hospital, treatment, doctor and implant lens. For more complicated surgeries like a kidney transplant, the variation could be from Rs 5 lakh to 12.5 lakh. This bid to ensure parity and fair pricing is now being driven by the IRDAI, General Insurance Council and insurers. The General Insurance Council, an association of insurers under the aegis of the regulator, has formed a committee to prepare a preliminary list of commonly claimed surgeries. Over time, the committee hopes to make their rack rate list more comprehensive by adding more players.

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“We should look at an FTA with the US. We have a trade surplus with them,” an official source told TOI. Another source said India was pitching for restoration of the entire GSP benefit, although the Trump administration has so far indicated a partial reinstatement of the concessional duty regime.

In recent years, the US has emerged as a crucial ally for India though differences over trade issues often cast a shadow on the burgeoning partnership. A trade deal with the US, at a time when worries over Chinese imports flooding the local market saw India walk away from RCEP, will underscore the growing convergence with the US as well as suspicions of the giant across the border. In the past, lobby groups such as the US-India Strategic Partnership Forum have suggested that an FTA could hold the key to resolving disputes.

A forward movement for the same will signal a major change of stand, considering the old wariness about the US stand on intellectual property rights, especially the patents regime for pharmaceuticals, as well as other areas of interest such as investment, where the US wants the same treatment for its companies as Indian entities even before they invest in the country.

In bilateral trade agreements, too, the US has usually sought a tighter regime for state-owned enterprises, which limits the space for governments to offer preferential treatment. India has always sought access for its software and other professionals in return for opening up its market by lowering import duties and offering other concessions.

But given the sensitivities on the visa regime, it is unlikely that the US will ease H-1B or other rules, something that Indian officials are conscious of. “Every country has its sensitivities, which should be factored in,” said a source. The US is India’s largest trade partner with imports and exports adding up to $88 billion in 2018-19. With exports of $52.4 billion, India had a trade surplus of $16.8 billion.

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