The Insurance Regulatory and Development Authority’s 100% cashless health insurance reforms have alarmed the Indian Medical Association (IMA). IMA state president Dr. T Senthamil Pari said policyholders will have to use “empanelled network hospitals,” limiting their doctor and facility choices…
The Tamil Nadu Indian Medical Association opposed the Insurance Regulatory and Development Authority’s 100% cashless health insurance changes.
IMA state president Dr. T Senthamil Pari said policyholders would have to use “empanelled network hospitals” starting Monday. These restrictions will limit their doctor and hospital choices. “In emergencies, they will have to find network hospitals and miss the ‘golden hour’. He added patients should be able to choose quality healthcare providers without being limited to cashless package costs. It would also bar non-empanelled hospitals from treating patients.
He stated packages would include consultation, diagnostics, in-patient care, surgery, and medications at a predetermined price.
Doctors say these rates will damage healthcare quality. “The low unscientific package rates fixed by insurance companies hinder optimal resource use, advanced technology use, and patient care,” stated IMA state secretary Dr. N R T R Thiagarajan. Government regulations (Clinical Establishment Act 2010, Minimum Wages Act, and IPH standards) outline hospital establishment, operation, and disease treatment. The insurance company’s package pricing make it untenable for hospitals to follow the recommendations. It may lower quality, he noted.
The government must contact experts to create a scientific health care costing template and revise it annually in addition to bringing back reimbursement modules. Doctors requested policyholder awareness programs.
Conclusion
The Indian Medical Association (IMA) has serious reservations regarding the Insurance Regulatory and Development Authority’s 100% cashless health insurance changes.
Key takeaways from the IMA’s concerns:
Policyholders would have to use "empanelled network hospitals," limiting their doctor and hospital choices. In emergencies, patients may not have time to find a network hospital.
Patients should be able to choose great healthcare providers without being limited to cashless package costs.
End-to-end prefixed costs for consultation, diagnostics, in-patient treatment, including surgery and medicine, could impair healthcare quality. The current low unscientific package rates set by insurance companies impede resource use, advanced technology use, and patient treatment.
Insurance company package pricing make it untenable for hospitals to follow government rules. This may lower healthcare quality.IMA has offered several solutions:
Return reimbursement modules.
The government must contact experts to create a scientific health care costing template and update it annually.
Policyholder awareness programs.The government should collaborate with the IMA to create a 100% cashless health insurance system that is fair to policyholders and providers.
