SC advises cheaper treatment for COVID in smaller towns, asks Centre to release insurance claims promptly

New Delhi - The Supreme Court recently suggested that there should be a cheaper treatment for COVID-19 infected patients in smaller towns and asked the Centre to consider the aspect of prompt release of claims by insurance companies which cannot keep their hands off at the time of the pandemic.

The apex court was told by the Centre that health is a state subject and primary responsibility in terms of management of COVID-19 rests with the states.

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In a report filed in the top court, the Centre proposed that states "may on a priority basis arrive at fair rates for private hospitals to ensure that there is no over-charging from COVID-19 patients or indiscriminate hikes for patients".

A bench headed by Chief Justice S A Bobde, which was hearing the pleas including the one filed by advocate Sachin Jain who has sought direction for regulating the cost of treatment of COVID-19 at private hospitals across the country, suggested that there should be cheaper treatment for coronavirus infected patients in smaller towns.

The top court made the suggestion after counsel appearing for private hospitals said that uniform price capping may not be feasible as it may vary in big and smaller cities.

The bench, also comprising Justices A S Bopanna and V Ramasubramanian, observed that insurance companies cannot keep their hands off at the time of pandemic and the government should consider the aspect of prompt release of dues by them.

The bench was told by an advocate appearing for private hospitals that price capping for COVID-19 treatment should not be made applicable in cases of co-morbidities.

The apex court has posted the matter for further hearing after 15 days.

The Centre, in its report filed in the apex court, has said that depending on number of cases and availability of health infrastructure in government set-up, states may consider exploring utilizing health facilities available in private sector to augment the available public health infrastructure for COVID-19.

It said that many states have also fixed rates for treatment of COVID-19 and communicated the same to private hospitals.

"The Ministry of Health and Family Welfare is of the view that while the decision for utilizing services of private sector rests with the states, a normative guideline may be provided to states to facilitate them for arriving at reasonable rates for the private hospitals to undertake COVID-19 treatment," it said, while proposing the guiding principles in this regard.

It said that states may arrive at rates for COVID-19 treatment after appropriate consultation with the stakeholders.

"States may consider Ayushman Bharat-PMJAY and/or CGHS rates as the benchmark basic rates. Certain states have already fixed rates for COVID-19 treatment in private hospitals in their states. The criteria adopted by those states may also be examined by other states in their own context," it said.

It further said that costing may consider parameters like the categorization of hospitals, illness, beds, tier wise categorization of cities and hospitals and the cost "ideally" should be all inclusive.

It said that COVID-19 treatment should be based on standard treatment protocols and on rational use of PPEs, as issued and circulated by the ministry, and states should set up a mechanism where such fair rates are given wide publicity and where grievances regarding overcharging can be redressed within fixed timeline.

The Centre also proposed that states should set up oversight mechanisms for monitoring and enforcement of rates and shall ensure that treatment rates so finalized be widely disseminated not only at state headquarters level but also at district and sub-district level making full use of media.

"The rates so fixed can be reviewed from time to time, keeping in view the possibility of reduction in costs of drugs, consumables and evolving clinical management protocols," it said.

The Centre informed the bench that as per the court's direction, it had accorded personal hearing to all the parties, including petitioner Jain, on July 16 and the issue was deliberated upon.

The top court had last month said that no one should be turned away from hospital due to higher cost of treatment.

It had asked the government to consider framing guideline on the issue of cost of treatment for COVID-19 infection.

In June, the apex court had asked private hospitals whether they were ready to provide treatment to COVID-19 infected patients at the charges prescribed under the government's Ayushman Bharat Scheme.

The 'Ayushman Bharat – Pradhan Mantri Jan Arogya Yojana' is aimed at providing health cover to poor and vulnerable persons in the country.

In its affidavit filed earlier in the top court, the Centre had said, "It is therefore submitted that the Central Government, within its statutory powers or powers of delegated legislation, cannot make this particular bifurcation for the lack of a requisite statutory framework for the said classification".

It had said that entire health infrastructure has been brought to most appropriate use for treatment of COVID-19 in the country and the Centre has taken several measures to strengthen public health facilities where medical care is provided free of cost to all patients.

"The care cost in the private sector is not regulated by the Central Government," the affidavit had said.

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