Maharashtra to review insurance kits for cancer patients

MUMBAI: The state plans to review the cost of radiation therapy packages offered to hospitals empanelled with the Mahatma Jyotiba Phule Jan Arogya Yojana (MJPJAY) insurance scheme for the treatment of cancer patients. It believes that the existing packages offer considerable profit margins, which make them lucrative and open to misuse.

After allegedly discovering that the high-cost radiotherapy packages (Rs75,000-Rs 1.5lakh) were "indiscriminately" recommended at private centres, the state has asked its third party administrators (TPA) to deny cashless approvals in cases where cheaper treatment choices were not advised. The scheme, which provides a cover of Rs 1.5lakh per family, has around 15 packages for radiotherapy, ranging from Rs 2,500 to Rs 1.5lakh. Overall, 971 packages across 30 specialties are covered.

"We may take a fresh look at the radiotherapy packages and bring down the cost. It will help eliminate any undue profit margins," said Dr Sudhakar Shinde, chief executive officer, State Health Assurance Society. The consumption of cancer packages-nearly six lakh-has been highest in the scheme since its inception in 2012. "Certain private centres earn up to Rs 5-6 crore annually from radiotherapy alone," said a state official.

Several private hospitals that are already at loggerheads with the government over the refusal of insurance claims, said any further reduction in package rates would make them unfeasible. There are 25-30 private centres offering radiotherapy across Maharashtra. "For certain treatments, the amount offered is Rs 2,500. Such rates were affordable over a decade ago, not today," said a Thane-based doctor.

A senior radiation oncologist said the state should instead work towards upgrading radiation packages. A doctor from a Latur centre said TPAs seldom pay the entire package amount. "They often deduct 25-30%."

The initial cost of starting a radiotherapy centre, including machinery, could be above Rs 15 crore. Experts say that even by conservative estimates, the monthly cost of running such a centre could run up to Rs 37-40 lakh. "It's possible that centres may be choosing higher packages to meet their basic running costs. But in the process, they are only giving superior treatment to patients. Any further reduction in package costs could come in the way of providing quality care," said a senior Mumbai doctor. The state official said the scheme cannot be used as a tool to recover business investments.