July 29, 2010

A year on, 1.5 lakh people treated under TN state health insurance scheme

Six-year-old Sivabalan, who suffers from blood cancer, wants to be a doctor when he grows up. On Friday, when the little one was invited to meet chief minster M Karunanidhi at his chamber in the state secretariat to collect a memento given by the state health department to select patients who benefited from the Kalaignar State Health Insurance Scheme on its first anniversary, he said, "I haven't joined school yet. But I would go once my chemotherapy cycles are over."

Sivabalan, who was diagnosed with acute lymphoblastic leukemia, a cancer of the white blood cells, when he was four, is one of the many beneficiaries of the scheme.

When the immature cancerous white blood cells multiplied in his body and crippled him, he was admitted under medical oncologist Dr P Guhan at the Ramakrishna Mission Hospital in Coimbatore. "We told Sivabalan's parents that there was a 80% chance of recovery if he underwent chemotherapy for 18 months. Since his father's monthly income was less than Rs 4,000, the hospital's trust sponsored his treatment for the first few months. For the last two times, his treatment has been sponsored under the state scheme. He will have more sessions under the scheme," Dr Guhan said.

The scheme was rolled out on June 23 last year after the state government signed an MoU with Star Health Insurance. Since then, smart cards have been issued to more than 1.33 crore families who belong to the low income group. The state has earmarked Rs 517.307 crores in the first year to families whose annual income is less than Rs 72,000 and to member's of the unorganised labour welfare boards. The treatment under the scheme is made available at more than 500 hospitals, both private and government, across the state for up to Rs 1 lakh.

"So far more than 1.5 lakh people have been treated at private and government hospitals under the scheme for various ailments," health secretary V K Subburaj said.

Apart from Sivabalan, more than 15 patients who had undergone surgeries of the heart, abdominal organs and bone repair, thanked the government for the insurance that allowed them to seek treatment in private hospitals. Doctors from several private hospitals including Sri Ramachandra University, Lifeline, Chettinad Hospital and Billroth Hospital in the Chennai, Ganga Hospitals in Coimbatore, Cancer Institute in Erode and Narayana Hrudayalaya in Bangalore were given certificates of appreciation.

Link: Original Article

July 28, 2010

Over 10,000 quacks doing biz in Kanpur city

Quacks are having a gala time in the city these days. As the change in weather has also led to a rise in the number of patients, the quacks are also getting their 'share of increased business'.

In order to crackdown on quacks, the district health authorities have launched several campaigns in the past few months.

But these campaigns have been failing due to lack of will and determination on the part of enforcement machinery. No surprise that every month several FIRs are lodged against such quacks, but lack of strict punishment or fine brings these 'Munna Bhais' back in the business.

"There are more than 10,000 quacks in the district who are flourishing well. It is difficult to tighten the noose around them for they have such a nexus that if we reach the spot immediately after getting any information, they are nowhere to be seen in their clinics," said the chief medical officer (CMO), Dr Ashok Mishra.

He further said, "Mostly quacks flourish well in slums and small villages. In the month of June and July, FIRs were lodged against six quacks who were caught red-handed. Five were from the city and one from Chaubeypur. These quacks were booked under Section 15 (3) of the Indian Medical Council Act 1956, Sections 1419, 420, 468 and 471.

Citing other reasons for the mushrooming of quackery in the city, the sources said that these quacks have a nexus with registered practitioners. A quack initially approaches a registered practitioner and offers him money for using his banner. These quacks appease the registered practitioners by offering them money.

It needs to be mentioned here that there are more than 1,800 registered allopathy doctors, 653 ayurvedic and unani doctor and 724 homoeopathy doctors in the city.

A health official said that practitioners having degrees registered with the Medical Council, Indian Medical Council (ayurvedic/unani), Homoeopathy Council and Dental/Surgery Council are considered genuine doctors, while the rest are impostors.

The sources in the health department pointed out that even if the department wants to proceed against the quacks for taking up medical practice in violation of relevant laws, a comprehensive mechanism, police force and required manpower are simply not available for the task.

"Our efforts are not justified till such quacks carrying out their illegal practice are not nabbed by the police," said an official.

As qualified doctors in the city charge high check-up fee, poor denizens are left with no option but to visit the unauthorised practitioners.

Seeta , a resident of Juhi areas, said, "We cannot afford to visit the doctors who charge exorbitant fee. We only go to doctors who charge reasonable fee."

Link: Original Article

July 27, 2010

Docs cannot run hospitals at residences: HC

The Allahabad High Court on Monday ruled doctors cannot run private hospitals or nursing homes at their residential premises. They can, however, set up consultation clinics in residential areas, a Division Bench comprising Justice Sunil Ambawani and Justice Kashi Nath Pandey said.

Dismissing a bunch of writ petitions filed by doctors from Etawah district, it said the Constituion which provides every citizen of the country the right to livelihood also empowers governments to impose "reasonable restrictions".

The Court observed running private hospitals or nursing homes in residential premises amounted to violation of the provisions under which land was allotted to doctors.

However, doctors could set up clinics for providing medical consultation at their residential premises, the Bench said.

The Etawah doctors had challenged the order of the Awas Vikas Parishad and the District Chief Medical Officer asking them to wind up nursing homes functioning from their houses.

Link: Original Article

July 26, 2010

Health sector reforms must cover us too: paramedical staff

Even as a serious move is on to bring about reforms in the health sector, particularly in medical education, a huge cadre of paramedical staff feels left out in this entire exercise.

The paramedical and allied health professionals, including the medical laboratory staff working in various scientific and clinical laboratories at various levels of health facilities, have been demanding a comprehensive legislation or a regulatory body to bring about uniformity in educational, employment and hierarchy, and quality of medical laboratory services in the country.

“Without a national perspective of medical technology and uniform standards of medical technologists, any improvement in the quality of health care is impossible,” Kaptan Singh Sehrawat, national convenor of the Joint Forum of Medical Technologists of India, told The Hindu. The Forum is a representative organisation of all medical laboratory staff associations under the Central government, the State governments and autonomous bodies. It is a stakeholder in the proposed Paramedical and Physiotherapy Central Council Bill, which was cleared by the Standing Committee in 2008 but lapsed due to dissolution of the 14th Lok Sabha.

There was talk that the government might revive the Bill but it seems the proposal has been put on the backburner once again as the Union Ministry of Health and Family Welfare intends to come up with a National Council for Human Resource in Health (NCHRH), which would be an overarching body for the health sector with several subsidiary bodies under its purview that would perform various functions.

“It is proposed that all existing councils and regulatory bodies would be covered under the NCHRH. However, while the government held discussions with other stakeholders, no effort was made to take our opinion before finalising the draft,” Mr. Sehrawat said.

At present medical technologists are not only professional graduates, but are post-graduates and even hold doctorates. “Our counterparts abroad are paid much higher emoluments and placed with respected designations such as Medical Laboratory Scientists and Laboratory Technologists having better promotional avenues.

Unfortunately, here we are still longing for basic salaries even in the Centrally-governed institutions due to lack of statutory council or regulations and uniformity in designations. Recruitment rules are outdated which do not reflect actual qualifications and work. Hence, various pay commissions failed to understand and appreciate this category of health stream,'' Mr. Sehrawat said.

Link: Original Article

July 25, 2010

Doctors, nurses joined Medicare scam, U.S. says

U.S. authorities charged 94 doctors, nurses and clinic owners with scheming to defraud the taxpayer-funded Medicare program out of $251 million, Attorney General Eric Holder said on Friday.

He said 36 defendants had been arrested so far in five cities in "the largest federal healthcare fraud take-down in our nation's history."

The suspects submitted false claims for equipment and services that were not medically necessary and in many cases not actually provided, Holder said. The claims were filed through the Medicare program that provides healthcare to elderly and disabled Americans.

"These criminals have siphoned resources from the most vulnerable among us," Holder said, referring to suspects in Miami, Detroit, New York, Houston, and Baton Rouge, Louisiana.

"With today's arrests, we're putting would-be criminals on notice: Healthcare fraud is no longer a safe bet. It's no longer easy money," Holder told a news conference in Miami.

The sweeping healthcare overhaul that President Barack Obama and his fellow the Democrats pushed through Congress in March relies partly on cutting waste and fraud to help offset the expansion of government-subsidized healthcare for more than 30 million uninsured Americans.

Fraud bleeds $60 billion a year from the Medicare program and South Florida is regarded as the national epicenter, accounting for a third of U.S. healthcare fraud prosecutions. That is partly because of the region's large population of elderly people and of non-English speakers, prosecutors have said.

Those charged on Friday included doctors, nurses, clinic owners and administrators and recruiters who persuaded patients to let their names be used on the claims.

"A lot don't understand how valuable their Medicare ID information is," said Department of Health and Human Services Secretary Kathleen Sebelius.

She said the government is working to educate people to better protect the information. It is also consolidating various Medicare data banks and using analytical tools similar to those used by credit card agencies to find suspicious billing patterns before claims are paid, Sibelius said.

Holder and Sibelius were in Miami on Friday for a healthcare fraud summit, the first of a series planned for other large U.S. cities.

More than 360 law enforcement agents from various federal, state and local agencies took part in the crackdown announced on Friday, Holder said.

Link: Original Article

H1N1 Vaccine mandatory for health care workers

Concerned over the failure of the States to utilise the A (H1N1) influenza vaccine even when the outbreak is at its peak, the Centre has now made the vaccine mandatory for health care workers.

In a letter addressed to the States, the Union Health and Family Welfare Secretary Sujatha Rao has said that as a matter of “great protection and in view of the nature of this epidemic, it is advisable to make this [vaccination] mandatory and ensure that all health care providers are vaccinated without fail…''

“You will also see there is some urgency in the matter as the life of this vaccine is not very long and needs to be utilised well before its expiry date,'' Ms. Rao said in her letter. It is absolutely essential to ensure that in all vulnerable facilities and areas the health care providers do not become carriers of this infection on the one hand and protect themselves from getting H1N1 infection on the other. For this they must get themselves vaccinated.

UTILISATION

The Ministry had last year imported 15 lakh doses of H1N1 vaccine from the French vaccine manufacturing company Sanofi Pasteur exclusively for the health care workers, of which 8 lakh doses were sent to the States for use on personnel dealing directly with H1N1 patients.

However, it was later realised that very few States actually utilised the vaccines. Maharashtra, which was the worst affected,received 34,000 doses but used just about 300 doses. Delhi, Uttar Pradesh and Rajasthan too did not use the vaccine on its health care workers.

The utilisation in these States was much less than 50 per cent while smaller States such as Arunachal Pradesh used 97 per cent, Daman (92 per cent), Tamil Nadu (77 per cent), Chhattisgarh (68 per cent), Gujarat (67 per cent) and Punjab (62 per cent).

On the other hand, Orissa utilised only 5 per cent of the stock, Manipur used about one per cent, Uttar Pradesh (17 per cent), and Chandigarh (15 per cent). The utilisation by Himachal Pradesh, Rajasthan and Madhya Pradesh was also dismal until last month.

Union Health and Family Welfare Minister Ghulam Nabi Azad had already written to the States to ensure utilisation of the H1N1 vaccines supplied to them.

Last week 330 cases of A (H1N1) influenza cases were reported. As many as 17 people died of the virus, including eight each in Kerala and Maharashtra and one in Andhra Pradesh.

This week two influenza deaths were reported from Delhi.

Link: Original Article

July 24, 2010

Accept our rates to get cashless plan: Insurers to hospitals

Locked in a battle with big healthcare firms over censoring cashless health insurance claims, state-run insurers on Thursday asserted that the facility would be extended only to those hospitals that agree to their rates for medical expenses.

"The purpose of working out such package rates and stabilising the hospitalisation costs, will benefit the insured in many ways," the four state-run general insurance companies -- National Insurance Co, New India Assurance Co, Oriental Insurance Co and United India Insurance Co -- said in a joint public notice.

Presumably hurt on their balance sheets by the allegedly inflated bills for medical costs of people covered by cashless mediclaim facilities, these insurers have pruned the list of hospitals in four large cities for providing this facility with effect from this month.

The selected list of hospitals in Delhi and National Capital Region, Mumbai, Chennai and Bangalore, does not include big chains like Fortis and Max Healthcare and was prepared on the basis of those accepting rate packages prepared by the insurance firms for medical procedures and hospitalisation costs.

While the insurers' move has been vehemently opposed by large hospitals, the general public has also been caused inconvenience as settlement claims for many of them were refused at the hospitals not on the preferred list for such a facility.

A conciliatory meeting was arranged between the insurers and the hospitals in Mumbai on July 13, after which the insurance firms agreed to work upon expanding the list of approved hospitals for cashless facility.

In today's statement, the four public sector insurers that together command nearly 65-70 per cent health insurance market share, however, made it clear that only those hospitals would be included in the list that adhere to its conditions on medical costs.

"We along with some TPAs (Third Party Administrators), worked out package rates for some of the procedures/ hospitalisation expenses, which are commonly claimed under our health insurance policies," the statement said.

Having offered these rate packages to various hospitals over a period of several months, those agreeing to the offer were included in a "Preferred Provider Network", or a network of hospitals where cashless mediclaim facilities would be available, the insurers said.

For treatment at non-PPN hospitals, the policy holders would need to seek reimbursement of expenses later.

Under cashless facility, the policyholders do not need to first pay the hospitals and later claim the expenses. Instead the insured sum gets deducted from the medical bills in the very first place.

With effect from July 1, the PPN model was made operational in Mumbai (74 hospitals), Delhi NCR (131 hospitals), Chennai (65) and Bangalore (58).

The insurers said that "many more hospitals have evinced interest in joining our PPN and we would be including them too." The insurers have also agreed to work with corporate hospitals and other stakeholders to devise a structure for expanding the PPN.

The four state-run companies also made it clear that their move to restrict cashless facility to approved hospitals would bring down the costs for the insured.

"Lower cost of every hospitalisation will leave a larger balance in the sum insured in the policy for future hospitalisation within the policy period."

"Lower cost will also reduce loading on policy premium at the time of renewal," they said, while adding that their step was "in the interest of all health insurance policy holders."

Link: Original Article

Mediclaim crisis looms, hospitals seek way out

The no-cashless crisis that has hit Mumbai and Delhi hospitals is not too far off and can lash Kolkata any day.

Phones at the offices of third party administrators (TPA) in the city have not stopped ringing ever since the refusals made it to the headlines. Most calls are from frantic consumers who want to know whether they have to pay from their own pocket the next time they get hospitalised.

Feeling the heat, major hospitals in Kolkata are fighting to find a way out. At the bottom of the problem is inflated bills, a charge of which city hospitals cannot be absolved of. Again, once the cashless facility is denied, those hit the hardest will be the patients and their family members. Among all patients getting treated at private hospitals around 25% to 30% avail of the cashless provision.

"Some hospitals in Kolkata are overcharging. This can't be denied and has to be stopped. We have started the process with Delhi and Mumbai. Chennai and Bangalore are next on the list. After that we will turn to other Metros including Kolkata," said an official of National Insurance Co Ltd.

On Thursday, the Association of Hospitals of Eastern India (AHEI) a conglomerate of major private healthcare providers in the city will hold a meeting. "We will discuss the issue there," said P Tandon, CEO Belle Vue and president of AHEI.

"There are loopholes in the system and have to be plugged. The insurance companies and hospitals have to come together and work out a solution. Fixing base prices could work out well," said Rupak Barua, COO of CMRI hospital.

A possible solution being projected by the hospitals is fixing the rates of services at the hospital, based on a classification of the hospital according to its number of beds and facilities available.

"Setting up basic rates appears to be the best solution in sight. It will benefit everybody. The infrastructure available with the hospitals can determine the category into which they will be clubbed," said a senior executive of a city-based Third Party Administrator.

At this moment, the public sector insurance companies haven't issued any instructions to the TPAs but the possibilities of a ban aren't ruled out. Health insurance providers in the private sector like ICICI Lombard and Bajaj Allianz haven't yet taken any such decision. When contacted spokespersons of both the companies said that they weren't taking any drastic measures yet. Sources in Star Health also ruled out any such move.

In Kolkata, hospitals and TPAs have been at loggerheads for years now. In December 2007, five TPAs were blacklisted by some of the big hospitals in the city for pending dues.

The issue is yet to be sorted out. Consumers who were enlisted with these companies found themselves at the receiving end as they were denied cashless as well as reimbursement.

If the insurance companies in consultation with TPAs decide on delisting hospitals, as has been done in Mumbai and Delhi, patients will be able to get reimbursement but not cashless services. For Delhi and Mumbai, insurance companies had asked the TPAs to prepare a list of hospitals which were "guilty of inflating bills." The hospitals were asked to mend their ways. Those who toed the line have been spared the rod, while the rest were served with a cashless-ban.

Some of the TPAs in Kolkata suggest that even mediclaim cardholders can be classified and be directed which hospitals they can go to. "This can be done on the basis of the sum insured of the mediclaim policy. Some complications can be sorted out. A patient with a mediclaim policy already knows how much he can spend through the card. So he should go to a hospital where he can get the treatment within the credit limit," suggest a TPA official.

TPAs have identified some problem areas where the hospitals are able to exaggerate the bills. One such area is the visiting consultant's fees. "There is just no cap to what a doctor may charge from a patient. The hospitals claim that they can do nothing about it since the doctor is a consultant and the patient wanted him. This has to be sorted out," a TPA official said.

Of late TPAs have started investigating cases where patients have had extended stays in the hospitals.

Insurance broking firms are not too happy with the developments in Delhi and Mumbai. "If the insurer doesn't want to continue with a particular hospital, it is fine. But changing policy facilities midway is unfair," said V Sahgal, managing director of Bajaj Capital Insurance Broking.

Link: Original Article

July 19, 2010

Eight new medical colleges for Gujarat

Undeterred by the Medical Council of India's rejection of its proposals for starting three new medical colleges in the current academic year, the Gujarat government has decided to set up eight new medical colleges in the state in the next two years.

Health Minister Jaynarayan Vyas Sunday said that the the state government is going ahead with the preparations to set up eight new medical colleges, including the three for which proposals for which were rejected by the MCI earlier. 'If not this year, we are sure to get approval for the same in the next year,' he said.

The Gujarat government has already requested the MCI to review the decision to reject the proposals for the three new medical colleges at Sola in Ahmedabad, Gotri in Vadodara and the K.J. Mehta medical college in Bhavnagar. A high-level team led by the state health secretary and the director of medical education have already discussed the issue with authorities concerned in Delhi.

Besides these three, the state government also proposes to set up a medical college each in Patan and Valsad while the locations of the three others, for which provisions were made in the current year's budget, would be decided soon, Vyas said. In addition, the Gujarat Cancer Research Institute had also proposed to set up a medical college in Ahmedabad, he said.

According to Vyas, two of the three colleges were granted permission earlier when Ketan Desai was the chairman of the MCI while a decision on the third was pending after the necessary inspections were carried out by the MCI team.

Following the arrest of Desai on graft charges, the MCI cancelled the previous permissions and put all the proposals for a fresh inspection by a new team which rejected the proposals.

It has only given the approval for the Adani Institute of Medical Sciences in Bhuj with a 150-seat capacity.

Link: Original Article

July 15, 2010

Health and HRD see eye to eye on medical education

The health ministry will collaborate with the human resource development ministry on the issue of accreditation of medical education institutions. The two ministries have been at odds over the control of medical education. The new draft of the National Council for Human Resource in Health (NCHRH) has proposed a subsidiary body, the National Committee for Accreditation, which will register and accredit medical colleges. In keeping with HRD ministry-piloted National Accreditation Regulatory Authority for Higher Educational Institutions Bill, the proposed National Committee for Accreditation will seek approval from the proposed authority.

Sources said the proposed committee will frame parameters and standards for accreditation, and then have these approved by the national authority proposed by the HRD ministry. It is likely that this committee, in turn, could set up further agencies for accreditation, which would operate within the parameters set out by the accreditation committee of NCHRH.

The health ministry has made it clear that even though the accreditation of medical education institutions would stick to the system laid out in the national authority proposed by the HRD ministry, this should not be seen as acquiescence on the issue of regulatory oversight.

“Medical education is too complicated and important and therefore regulatory structures must have technical expertise to be able to take informed decisions. Also, the proposed regulatory body National Commission for Higher Education and Research vests the power of deciding about institutions to universities. Accreditation of medical institutions and academic content requires technical expertise. Once the institutions are found to be acceptable by the NCHRH, the institutions can approach universities for affiliation,” a senior official said.

The issue of regulatory oversight still remains unresolved. The HRD ministry has argued that the task force which is preparing the framework for the National Commission for Higher Education and Research is keen to bring medical education under its fold. HRD ministry officials have argued that till the task force submits its report to the minister, no final decision on the issue can be taken. Interestingly, even as the HRD ministry has decided to keep the issue of regulatory oversight on medical education in abeyance, the Prime Minister’s Office has made it clear that medical education would fall within the purview of the NCHRH.

In keeping with this mandate, the health ministry has reworked the NCHRH. In the proposed overarching body for the health sector, activities have been separated as much as possible. The proposed NCHRH Bill provides for setting up several subsidiary bodies each of which will independently perform one of the many essential tasks in governing medical education, all of which are currently performed by the Medical Council of India (MCI).

Link: Original Article

Insurers hire agencies to verify medical claims

Insurance companies, which are bleeding because of what they claim are inflated claims, have been relying on special investigating agencies to verify the authenticity of several of these claims.

Aditi Kamath of Escalate Consultants Services, which specialises in investigation of fraud claims, said, "Services of super-speciality consultants, auditors and medico-legal experts are now taken to go into the depth of the matter. The work profile includes verifying diseases, documents, medical reports and providing clinical judgement on matters deemed suspicious."

"Besides hospitals, many of the inflated claims are also made by patients who are hand-in-glove with medical professionals and, sometimes, third-party administrators (TPAs)," another consultant said. "Insurance firms are suspicious of some TPAs whose investigations they feel are not credible," he said.

But there are only a handful of specialised agencies carrying out investigations on behalf of public- and private-sector insurance companies in Mumbai. Insurance firms pay anything between Rs 8 crore and Rs 10 crore annually and industry experts say business is likely to grow because of the rising number of referrals.

Approximately 400 cases for spot investigation and 25 cases for detailed investigation are referred by insurance firms or TPAs to these investigating agencies in Mumbai a day. "In spot investigation cases, our role is to merely verify the identity of the patient, class of accommodation, ailment and justification for hospitalisation," Kamath said.

Instech Advisory Services vice-president Bhusan Patil said, "Some firms also ask us to carry out detailed investigation. Specialised doctors' help is to taken to inquire into the whole gamut of treatment, including whether the patient had any pre-existing ailment, excess medical bills by hospitals, nature of ailment, authenticity of medical reports and justification for the treatment."

More challenging is the task of investigating personal accidents claim for disability calculation. Kamath said, "We have orthopaedics, who worked as civil surgeons, to evaluate the disability percentage in claims under personal accident policy. It is a specialised task, which involves examining patients as well as making discreet enquiries with neighbours, employers and relatives to determine the disability's magnitude."

On why insurance firms were placing claims under the microscope, another industry insider said: "Thirty per cent of the cases are found to be doubtful in spot investigations. And patients are found to never have been hospitalised in 5% of the cases. Sometimes, policy holders have never been hospitalised, but have claimed insurance benefit by submitting forged documents; in some cases, the actual patient is found to be the claimant's relative or friend. Some hospitals have lodged claims in the name of policyholders who never underwent any treatment. Sometimes, hospitals too have used fake policies." Patil said: "It is a high-risk job and many of our team members have been threatened by hospital staff who committed the fraud."

Link: Original Article

July 14, 2010

Reliance Life bets big on health cover

Anil Ambani-promoted Reliance Life Insurance is bullish on the growing health insurance market and expects to sell over a million policies this fiscal.

“There is a huge growth potential in the health insurance segment in India. We plan to tap the highly under-penetrated market to be among the top three insurers by 2012 and sell over one million policies this year,” president and executive director Malay Ghosh told The Telegraph.

At present, Reliance Life has a minimal presence in the segment, which is dominated by general insurance firms such as Bajaj Allianz, ICICI Lombard and Tata AIG, among private players.

According to a report by global research firm RNCOS, the health insurance market premium is expected to grow at a compounded annual rate of over 25 per cent between 2009-10 and 2013-14. Premium collections touched $1.31 billion in 2008-09, the Insurance Regulatory and Development Authority (IRDA) said in its annual report of 2008-09.

Reliance Life, which crossed the 60-lakh mark in total policy sales last month, plans to strengthen its portfolio with innovative products that include total reimbursable health expenses, individual and family floater on both group and individual product platforms, and long-term care.

On the recent withdrawal of cashless facility by many insurers, the company said it would seek certain clarifications from the IRDA before taking any action.

Industry experts said although the health insurance market expanded rapidly in the past couple of years, it remained largely under-penetrated. “Some of the critical shortcomings include low awareness, non-coverage of out-patient care and existing diseases, inefficient cost management, product reach in rural areas and weak retail distribution model,” stated the RNCOS report.

“Apart from a strong product line, quality customer service, reach and training are what creates a highly differentiated product,” Ghosh said.

The company aims to break even by the end of this fiscal.

Link: Original Article

Hospitals cry foul over curb on cashless cover

Insurance companies, which are bleeding because of what they claim are inflated claims, have been relying on special investigating agencies to verify the authenticity of several of these claims.

Aditi Kamath of Escalate Consultants Services, which specialises in investigation of fraud claims, said, "Services of super-speciality consultants, auditors and medico-legal experts are now taken to go into the depth of the matter. The work profile includes verifying diseases, documents, medical reports and providing clinical judgement on matters deemed suspicious."

"Besides hospitals, many of the inflated claims are also made by patients who are hand-in-glove with medical professionals and, sometimes, third-party administrators (TPAs)," another consultant said. "Insurance firms are suspicious of some TPAs whose investigations they feel are not credible," he said.

But there are only a handful of specialised agencies carrying out investigations on behalf of public- and private-sector insurance companies in Mumbai. Insurance firms pay anything between Rs 8 crore and Rs 10 crore annually and industry experts say business is likely to grow because of the rising number of referrals.

Approximately 400 cases for spot investigation and 25 cases for detailed investigation are referred by insurance firms or TPAs to these investigating agencies in Mumbai a day. "In spot investigation cases, our role is to merely verify the identity of the patient, class of accommodation, ailment and justification for hospitalisation," Kamath said.

Instech Advisory Services vice-president Bhusan Patil said, "Some firms also ask us to carry out detailed investigation. Specialised doctors' help is to taken to inquire into the whole gamut of treatment, including whether the patient had any pre-existing ailment, excess medical bills by hospitals, nature of ailment, authenticity of medical reports and justification for the treatment."

More challenging is the task of investigating personal accidents claim for disability calculation. Kamath said, "We have orthopaedics, who worked as civil surgeons, to evaluate the disability percentage in claims under personal accident policy. It is a specialised task, which involves examining patients as well as making discreet enquiries with neighbours, employers and relatives to determine the disability's magnitude."

On why insurance firms were placing claims under the microscope, another industry insider said: "Thirty per cent of the cases are found to be doubtful in spot investigations. And patients are found to never have been hospitalised in 5% of the cases. Sometimes, policy holders have never been hospitalised, but have claimed insurance benefit by submitting forged documents; in some cases, the actual patient is found to be the claimant's relative or friend. Some hospitals have lodged claims in the name of policyholders who never underwent any treatment. Sometimes, hospitals too have used fake policies." Patil said: "It is a high-risk job and many of our team members have been threatened by hospital staff who committed the fraud."

Link: Original Article

July 13, 2010

Insurance cos slash list of hospitals for making fraudulent claims

There’s bad news for public sector health insurance policy holders who hitherto had a wide range of hospitals offering cashless benefits to choose from. Following the unearthing of several instances of allegedly fake claims made by hospitals in collusion with patients and third-party administrators (TPAs), public health insurance companies have drastically cut down the list of hospitals in Mumbai, Delhi, Chennai and Bangalore.

Top city hospitals which are off the list include Cumbala Hill Hospital, Breach Candy, Bhatia Hospital, Lilavati, Hinduja and Jupiter. However, some of these hospitals have voluntarily opted out on the grounds that the new rates fixed by the insurance agencies are too low. The agencies are still negotiating with Bombay Hospital and Jaslok.

Several hospitals are still in the dark about the curtailed list, as they have not been informed either by the TPAs (who settle claims on behalf of insurance companies) or the companies themselves. "I am not aware of our hospital being taken off the list of public sector health insurance companies," said Vijay Krishna, CEO, Breach Candy Hospital. "But our agreement is with the TPAs, not with the companies. I will discuss this with the TPAs to know more about this issue." Dr Sujit Chatterjee of L H Hiranandani Hospital also said he had heard nothing officially about this exercise. An official from an insurance firm said the hospitals would soon be informed.

Sources said the public sector insurance firms, which have an 80% market share in this segment, collected premiums worth Rs 900 crore per annum from Mumbai region. "As against this, they had to shell out Rs 1,200 crore annually towards claims — a loss of Rs 300 crore per year," said the source. Alarmed at the trend, New India Assurance Company decided to undertake an exercise to cut down the mounting losses incurred on account of fake claims. Oriental Insurance Company, National Insurance Company and United India Insurance company also decided to lend their support to this exercise, which was carried out by MD India Health Care services. The General Insurance Public Sector Association, the parent body of government-owned health insurance firms, then decided to take these corrective measures.

"There were over 800 hospitals providing cashless benefits to patients insured by public health insurance companies in Mumbai," said Dr Mohammed Mukhtar, health strategist and manager, MD India Health Care Services. "Most of the hospitals were inflating the bills submitted to insurance firms. Apart from blacklisted hospitals, the insurance firms decided to exclude hospitals which don’t have adequate infrastructure from the Preferred Provider Network."

Link: Original Article

July 11, 2010

Medical seats: Andhra Pradesh may agree to all-India sharing

HYDERABAD: Medical aspirants from the state will get a chance to choose from the best medical colleges from across the country if the state finalises a proposal to allow students to appear for the common pre-medical test (CPT), a test conducted for admission into MBBS courses. This would happen only if the state government brings out a rule opening up its medical colleges to students from other states.

Currently, the state’s medical colleges give admission only to local students. The CPT move will help students to choose from over a 100 medical colleges in the country, which would be helpful given that the state is faced with a shortage of medical seats. Officials said that the state government is reconsidering its medical seat sharing rules following the recent announcement by Union HRD minister, Kapil Sibal, that a common entrance test for both medical and engineering colleges will be in place from 2011.

“If the state sticks to its current rule of denying admission to students from other states, our students will not be allowed to take part in the national medical test. Hence talks are on at the state level to do away with the no seat sharing rule,” said an official from the department of medical education. The state government has been conducting talks with the Centre over the last few days, officials said.

According to officials from the directorate of medical education, the final decision on the matter will be taken by chief minister, K Rosaiah.

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Medical advice via Internet is injurious to health

Patients using Internet search engines to find a remedy for their injuries or illnesses may end up getting wrong or incomplete diagnoses.

A report in the latest issue of the Journal of Bone and Joint Surgery suggests that injuries are aggravated when patients attempt their own treatments.

Information about the most common sports injuries varies widely in quality, according to the study, which found newspaper articles and personal websites the least accurate information sources, Daily Mail reported.

"The reason that we decided to undertake this study is that patients are presenting to their physicians office with increasing frequency armed with printouts of information obtained from the internet," said Madhav A Karunakar, an orthopaedic surgeon and study author.

"Physicians and patients should be aware that the quality of information available online varies greatly," he said, adding that quality contents over health information on the web have not grown at the same rate that internet use has.

The study authors chose 10 of the most common sports medicine diagnoses and reviewed the online information available on them.

Using the two most frequently used search engines - Google and Yahoo - the experts reviewed the top 10 search results for each diagnosis, looking for completeness, correctness, and clarity of the information.

They also noted whether the site's owner was a non-profit organisation, news source, academic institution, individual, physician, or commercial enterprise.

In terms of content, Karunakar said, non-profit sites scored the highest, then academic sites (including medical journal sites), and then certain non-sales-oriented commercial sites.
Commercial sites such as those sponsored by companies selling a drug or treatment device were very common but frequently incomplete.

"About 20 percent of the sites that turned up in the top ten results were sponsored sites," Karunakar said.

"These site owners are motivated to promote their product, so the information found there may be biased.
"We also found that these sites rarely mentioned the risks or complications associated with treatment as they are trying to represent their product in the best possible light."

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July 10, 2010

Docs want rules relook - Practical guidelines sought

A section of doctors has called on India’s apex medical regulator to develop “rational and easy-to-follow” rules to replace the blanket ban announced last year on physicians accepting cash, gifts, travel or hospitality benefits from pharmaceutical companies.

The Medical Council of India (MCI) had introduced the ban last year amid widespread concerns even within the medical community that incentives from drug companies to doctors were influencing prescription patterns and hurting patient care.

The MCI had specified that any doctor who accepts an incentive worth more than Rs 1,000 would be liable for punishment.

The rules had drawn criticism with doctors pointing out that it would be difficult to enforce. Critics have also argued that most travel funding from the drug industry goes into supporting continuing medical education.

“The guidelines must be transparent and implementable,” said Sanjeev Bagai, a senior consultant pediatrician at the Batra Hospital and Medical Research Centre, New Delhi, speaking at a panel discussion on medical ethics here. “Personal gifts have tainted the medical profession — but (support for) continuing medical education, research and training is important,” he said.

“Doctors need to regulate themselves — determine for themselves what’s right and what’s wrong,” said Ashok Seth, president of the Cardiology Society of India, New Delhi, and a consultant at the Fortis Escorts Heart Institute.

“Family jaunts, exorbitant gifts, travel to exotic locations, and incentives to influence research are sins,” Seth said. “There is a need to protect patients from biased medical practices that emerge under the influence of such sins.”

However, Seth said, the pharmaceutical industry resources may also help improve patient care.

Doctors sponsored by the industry may learn new technologies and disseminate them to other doctors through continued medical education courses.

The head of the new governing board of the MCI on Thursday indicated that the issue posed a challenge to regulators. “In the US, doctors have to pay on their own to attend continuing medical education courses,” said Shiv Kumar Sarin, the head of the six-member panel governing the MCI, at the seminar. “Are doctors in India ready to do this?” he asked.

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July 09, 2010

Everyone can be a lifesaver

In an attempt to educate the people of Karnataka on medical emergency and treatment, Apollo Hospital is launching a citizen training initiative — Apollo Community Training on Medical Emergency (ACTME). This is probably the first-of-its-kind programme empowering ordinary citizens to handle medical emergencies.

"It’s a myth that only doctors can save lives. The common man, too, can do the same. The right kind of training and awareness can equip anyone to handle medical cases. There are a few basic steps, which can be used to handle emergencies anywhere, be it in school, home or the marketplace", said Dr A N Venkatesh, consultant and HoD (emergency), Apollo Hospitals, who will be spearheading the project.

Link: Original Article

July 08, 2010

Accepting gifts: Docs ask why they're singled out

Tired of being the only ones being named and shamed for corrupt practices such as accepting gifts and hospitality from the pharmaceutical industry, prominent doctors sought legislation for "all stakeholders", including the pharma industry, involved in bribing of doctors. The doctors questioned why they alone were being targeted and made liable in such cases.

The issue of involving all stakeholders in the problem of doctors being bribed was discussed at a seminar on the occasion of Doctors' Day on Thursday. The seminar, titled 'Medical Ethics: Where Are We Going', was organized by Batra Hospital in association with the Heal Foundation and Fox Mandal Little, a law firm that handles cases related to the medical profession.

Dr S K Sarin, chairperson of the board of governors appointed to replace the Medical Council of India (MCI) and the main speaker at the seminar, said that he personally believed that delegates attending continuing medical education (CME) conferences ought to pay for themselves as that would make them more serious about attending, listening and participating in the lectures. Dr Sarin added that a working group had been formed to go into the question of medical ethics.

Dr Sanjeev Bagai, CEO of Batra Hospital, pointed out the lack of any course on medical ethics in medical education in the country. He called for a consensus on guidelines regulating doctors which could be "rational, easy to follow, practical and easy to implement". Dr Bagai suggested that in the matter of funding, associations of doctors be given priority over individual doctors.

Sudhir Mishra of Fox Mandal Little questioned why the regulation on bribery of doctors through gifts and hospitality was affecting only doctors without considering other parties. "MCI has no direct control over the pharma sector. The health ministry needs to bring in legislation for the pharma sector," said Mishra.

Earlier, acting on some complaints MCI received on the issue of pharma industry bribing doctors, when the council sought names of doctors from the pharmaceutical companies, none were forthcoming. The council had then approached the health ministry to empower the Drugs Controller General of India to take action against companies that induced doctors to violate the law. However, with the pharma industry being allowed to self regulate and with the ministry bringing in no legislation to tackle their role in bribing doctors, the companies continue the practice, safe in the knowledge that the current regulation would only affect the doctors and not the company bribing the doctor.

Link: Original Article

July 07, 2010

Common entrance test for medical courses mooted

The newly constituted Board of Governors of the Medical Council of India (MCI) has proposed a common entrance test for undergraduate and postgraduate medical courses in the country.

It is in consultation with the Central Board of Secondary Education (CBSE) to work out the details for introducing the system from the next academic year.

The Board, constituted after the dissolution of the MCI on May 24, has already approached private medical colleges with the proposal, with some having informally expressed their support for it.

“The Director-General of Health Services is in the process of consulting the States and working out the finer details, and a final system will be announced by the end of next month,” S.K. Sarin, chairman of the Board, told journalists here on Tuesday.

“We hope to have a common entrance test by the next academic session,” Dr. Sarin said, adding that a single entrance test would reduce the stress level of the students, who at present have to sit for a minimum of seven tests to get admission to medical colleges.

There are about 17 entrance tests held across the country for admission into medical colleges with the CBSE, State governments and some private colleges having their own entrance examinations.

“We have already contacted the CBSE. It will decide how to go about it, including the syllabus. The test will cover all government, private and even minority institutions,” Dr. Sarin said.

“We are also consulting legal experts to study various judgments on the matter and look into the cases pending in the courts in this regard, including reservation in minority institutions, NRI seats and management quotas,” he added.

MERIT FOR RESERVED SEATS

According to Devi Shetty, member of the Board, a minority educational institution could have a minority quota and a private college could have a management quota, but the reserved seats would have to be filled on the basis of merit.

The MCI Board will also discuss the matter with the Human Resource Development Ministry that earlier this month announced a common entrance test for medical and engineering courses by combining the Pre-Medical Test (PMT) and the All-India Engineering Entrance Examination (AIEEE).

Of the 32,000 undergraduate seats in the country available annually, the CBSE conducts the test for 15,000 seats. And, there are 13,000 postgraduate seats in medical colleges are filled every year.

Also supporting the idea of an “exit” test, Dr. Sarin said the Board was going ahead with educational reforms, adding that medical education should remain with the Health Ministry.

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Doctors told to keep prescriptions ‘generic’

Doctors in Delhi’s government-owned hospitals and clinics will have to prescribe medicines by their generic name (chemical name) and not by the costlier brands of a particular company. “The officers of Drugs Control Department have been instructed to monitor the prescriptions issued by doctors in hospitals and dispensaries under Delhi government,” a directive of the state government issued earlier this month said. As per the Delhi government’s website, it runs about 30 hospitals in the city state.

Prices of generic drugs which have the same thereupatic qualities are significantly lower than their branded versions. For example popular brands of paracetamol, used to treat headache, cost Rs 10 for a strip of 10 tablets (500 mg). Its non-branded generic equivalent costs as less as Rs 2.45 for the same batch of tablets.

Unlike other consumer products, patients cannot choose from different brands or don’t know their generic equivalent. They buy only the particular brand the doctor prescribes. Drug companies spend huge amounts of money to promote their brands and convince doctors to prescribe their product over others. In return, doctors are given lucrative gifts and incentives, an unethical practice the government is trying to address separately.

The Delhi government’s move follows similar steps by the union health ministry and the state government of Rajasthan. Last month, the union health ministry asked all central government hospitals and autonomous institutions to mandatorily mention the generic name of a drug when they prescribe a medicine.

“This will curb the often observed practice of prescribing specific brands of medicine with a rider that no substitute should be supplied,” a union health ministry statement said. The Delhi government directive has also asked state-run hospitals and dispensaries to open more generic drug stores under the Union government’s Jan Aushadhi programme. Under the initiative launched last year medicine outlets in the hospitals will sell low-cost version of drugs. The move is a step towards the governments’ plan to reduce the cost of healthcare.

Link: Original Article

July 04, 2010

Working in Rural areas under contract will also count for PG Entrance: Supreme Court

The Supreme Court today ticked off doctors for their reluctance to work in rural areas and said they could not expect special benefits if they chose to enjoy the comforts of urban lifestyle.

“People (doctors) are not willing to go to the rural areas. Unless there are incentives, how do you expect them to go to the rural areas? Those in the rural areas do not have any facilities,” the bench of Justices R.M. Lodha and A.K. Patnaik said sarcastically. “You (urban doctors) want to enjoy everything in the urban areas and do not want to serve in the rural areas.”

The judges stayed a Karnataka High Court division bench order that said the work experience of doctors serving in the rural areas on a contract basis was not eligible for special weightage for postgraduate courses. A division bench of the high court had set aside a single judge’s order that had upheld the weightage for such doctors at the time of applying for postgraduate courses.

The weightage was meant for doctors working in the rural areas on contract who were subsequently absorbed into regular service.

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2011 may see a common entrance test for all medical colleges

A common entrance exam for all medical colleges -- public or private -- for both undergraduate and post graduate courses could soon be in place, possibly as early as the next academic session.

The six-member panel set up by the health ministry to run the Medical Council of India (MCI) has suggested institution of a common entrance exam, modalities of which will be finalised in the next two weeks.

Speaking to TOI, member of the panel Dr Devi Shetty said, "At present, a student wanting to study medicine has to appear for 10-15 examinations, which can be highly stressful to both the student and his family. A common entrance exam will allow a student to give his best shot at one go."

Dr Shetty, however, made it clear that students will apply separately to every college in accordance with their preferences, be it AIIMS, PGI Chandigarh or a private medical college, after taking the exam. A student will need to score in order to get admissions to the colleges of choice.

The panel's proposal will not change the overall availability of seats in the country but even quotas will be filled in accordance to test results. "Quotas will continue. But for example if the management of a private college holds 25% of the seats, we are saying that they should be given according to merit and the marks the students get in this common test rather than arbitrary distribution," Dr Shetty said.

Having received complete backing from the health ministry, as claimed by Dr Shetty, the panel has held consultations with the Central Board of Secondary Education (CBSE) for the proposed common entrance test.

Dr Shetty said, "In all government medical colleges, the test for 15% of the seats at the undergraduate level at present is conducted by CBSE. We want this to be extended to all seats. CBSE is highly favourable to this plan and so is the Union health ministry which gave the clearance months ago."

He added, "The proposal has also been keenly welcomed by most private medical colleges who have have expressed their willingness to get on board with us. However, we are presently consulting legal authorities to look at how to execute the programme, considering that private medical colleges at present have the right to conduct their own exams. We are in the process of consensus building."

President of the panel Dr S K Sarin said, "A common entrance will reduce hassles for students appearing for multiple medical exams. The health ministry is supportive of the idea."

Union health secretary K Sujatha Rao told TOI, "Nothing has been finalised as yet and we have not got a formal proposal. The idea of a common entrance exam is a good thought and there has been a huge demand for it. But we are yet to figure out how to roll it out as it will be a major policy deviation."

Reacting to the proposal, chairman of the National Board of Examinations Dr K S Reddy told TOI from Geneva, "In principle, a common entrance exam is fine for students but the requirements of providing opportunities for in service candidates or doctors working in rural areas to obtain access to post-graduate training must also be protected."

Link: Original Article

Two TN medical colleges did demand capitation fee: CBI

CBI has confirmed the expose by Times Now-TOI in May 2009 and said there was a clear involvement of Ramachandra Medical College and Research Institute (RMCRI) as well as Bharath Institute of Higher Education and Research (BIHER), both in Tamil Nadu, in demanding capitation fee for admission to MBBS course.

CBI has also made it clear that officials of the two institutes were not seeking capitation fee in their personal capacity but there was clear involvement of the two deemed-to-be universities.

Strangely, though the CBI demanded withdrawal of deemed-to-be university status of both the institutes, the report submitted in Novembar 2009 has been lying with the HRD ministry for the past seven months without any action.

In case of RMCRI, CBI has said that A Subramanian, deputy registrar (academic), associated with the institute for more than two decades, demanded capitation fee on behalf of the institute. CBI said the institute did not lodge any complaint against him with the local police nor took any harsh action for his misconduct. Times Now had shown Subramanian demanding the capitation fee.

During the probe, CBI analysed the common entrance test of RMCRI and found that question papers for the medical entrance test were being prepared by C Satish, principal of DAV School, Chennai, for many years. But the real shocker is that Satish has a Ph.D in commerce. The institute's office-bearers, including its chairman, failed to explain the engagement of Satish for setting up of question papers for years continuously, CBI said.

In addition, the answer sheets along with question papers of the common entrance test of previous years were not provided during the course of inquiry on the pretext that they have been destroyed as per university resolution, the agency said in its report.

The CBI also found that the common entrance test of Shri Ramachandra deemed-to-be university was being managed by one or two office-bearers who owed allegiance to the chairman of the university. No independent committee had been set up to maintain the standards of entrance test, CBI said.

In case of BIHER, CBI has named TA Johnson, supervisor (maintenance) and V Lakshmi, deputy warden, Sree Balaji Medical College and Hospital, as the persons demanding capitation fee on behalf of the institute.

The CBI found that there is no system in place for the publication of the list of successful candidates in the common entrance test. After analyzing its common entrance test, CBI said it raised doubts about its transparency and fairness. The university failed to provide the names of the resource persons engaged for setting the question papers for the common entrance test, the agency said. Like in the case of RMCRI, one or two persons owing allegiance to the chairman of the university were conducting the test in BIHER. Even BIHER could not provide the answer sheets of the common entrance test of previous years.

CBI also says that it examined the chairpersons and members of the UGC and MCI-appointed committees set up to probe the matter and they also said that the money was demanded for the institute and not for personal benefit.

Link: Original Article

July 01, 2010

India has shortage of six lakh doctors ; Health Minister

India has a shortage of 600,000 doctors and 10 lakh nurses, Union Minister of State for Health Dinesh Trivedi said on Friday.

To combat the human resources shortage in the healthcare sector, Trivedi laid stress on more private-public partnerships.

"Currently there is a shortage of 6 lakh doctors and 10 lakh nurses," the minister said while addressing a Confederation of Indian Industry (CII) programme.
Trivedi said he was not in favour of propagating health tourism because it would create more pressure on the healthcare system.

Trivedi said the union health ministry has adopted a three-pronged initiative in April that encompasses initiatives like a comprehensive National Health Portal, a 24-hour 3 digit National Emergency Media Service Number and I- HIND (Indian Health Improvement Network Information Development).

Link: Original Article

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