The Union Ministry of Health and Family Welfare (MoHFW) has filed an affidavit in Supreme Court proposing certain suggestions for the cost effective treatment of COVID-19 patients across states after having convened a meeting with the relevant stakeholders, in accordance with directions passed on July 14, 2020.
The Court is informed that a personal hearing was accorded to all stakeholders, including the petitioner, by Additional Health Secretary, Ms. Arti Ahuja, on July 16, and their written submissions were sought by the end of the evening. A copy of the submissions made by each organization/stakeholder has also been attached for the Court's perusal.
In the report, filed under the name of the Deputy Secretary, MoHFW, it has been stated that some non-mandatory guidelines may be issued to state governments in accordance with these suggestions presented by the petitioners and intervenors.
However, the Centre has reiterated that Health is a State subject and it is upon the States to work out a system in accordance with the number of active cases and infrastructure available with the government.
"It is to be highlighted that Health is a State subject and primary responsibility in terms of management of Covid-l9 rests with the Sates. Depending on the number of cases and availability of health infrastructure in government set-up."
With regard to using infrastructure from the private sector, it is submitted that "States may consider exploring utilizing health facilities available in private sector to augment the available public health infrastructure for COVID- 19. Many States have also fixed rates and communicated the same to private hospitals."
On July 14, the Supreme Court had asserted that it would not formulate a uniform cost and regulatory mechanism for COVID19 treatment and observed that it was not possible to lay down the cost of treatment for medical care throughout the country as different states had different needs and requirements.
It had thus asked the Centre to place a decision before it within a week, for approval of directions to be issued under the National Disaster Management Act to various states.
The Union Ministry has stated that they have taken on record the aforementioned observation, that it is not possible to determine/lay down the uniform cost structure for treatment of patients suffering from COVID-19 throughout the country, made by the Chief Justice of India, SA Bobde.
However, in order to facilitate States in arriving at reasonable rates to ensure private hospitals undertake COVID-19 treatment, it is suggested that certain "normative guidance may be provided" to them.
Towards this end, with due consideration of the situation, the following 10 guiding principles have been suggested and placed before the Top Court
- States arrive at fair rates on priority basis to ensure there is no over-charging of COVID-19 patients
- Consult appropriate stakeholders to arrive at these rates
- States may consider Ayushman Bharat-PMJAY and/or CGHS rates as the bench mark, or perhaps look to integrate the criteria adopted by other States who have already fixed treatment rates
- Costing may be based on parameters such as categorizing hospitals (Accredited and non-accredited or on the basis of secondary and tertiary care or on the basis of number of beds in a hospital), illnesses (Mild, Moderate, Severe), beds (isolation, supplemented with oxygen, ICU with ventilator, etc.) and tier-wise cities
- Make it an all-inclusive lump-sum cost, which includes everything associated with the treatment from safety gear to medication to procedures, as well as consumables, transport, referrals, etc.
- Treatment be given according to Standard Treatment Protocols. PPE kits be used rationally, as per issuance by the Union Health Ministry
- States may publicize the rates that are fixed, and set up a mechanism to ensure grievances regarding overcharging can be accordingly redressed
- States may also set up a mechanism to monitor that the rates which have been fixed are enforced in hospitals
- The rates finalized must be communicated to the district and sub-district levels by using print and electronic media to its fullest capability
- States me go back to the rates and review them from time to time, keeping in mind the possibility of reduction in the cost of drugs and other variables
While passing directions, the Supreme Court bench comprising of Chief Justice SA Bobde along with Justices R Subhash Reddy and AS Bopanna, on July 14 had stated that "the cost of medical treatment must not act as a deterrent against access to medical care particularly in the present times and no one should be turned away from the doors of healthcare institutes because the cost of treatment is too high".