Healthcare leaders question govt treatment rates, call for scientific costing

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Hospital executives said healthcare pricing and reimbursement must reflect the actual cost of delivering quality care, while flagging gaps

By Ankita Upadhyay

Updated - October 28, 2026 at 08:58 PM.

Amid concerns over the high cost of healthcare in India, hospital and industry leaders have questioned whether government-determined treatment rates adequately reflect the cost of delivering quality care, calling for scientific costing studies to guide pricing and reimbursement.

At a panel discussion organised by FICCI Heal, executives argued that pricing decisions must account for clinical standards, patient outcomes and hospitals’ financial sustainability, rather than focus solely on affordability.

“There has been no proper costing study done in this country,” said Dr Ashutosh Raghuvanshi, MD and CEO of Fortis Healthcare. “The government needs to understand that it has to be a scientific thing,” he said, referring to reimbursement rates under government healthcare schemes.

CGHS Rates

Raghuvanshi questioned comparisons between public and private hospital charges that overlook differences in funding, infrastructure and operating costs. He also flagged the revision of Central Government Health Scheme (CGHS) rates after a gap of roughly a decade, arguing that reimbursement changes needed a clearer scientific basis.

Hospitals sometimes accept financially unattractive reimbursement rates to utilise spare capacity, he said, but such arrangements are not necessarily sustainable.

“The quality and the price are not kind of exclusive. It’s not that only high price is high quality or vice versa,” Raghuvanshi said, arguing that affordability and quality need not be mutually exclusive.

Cancer Care: Balancing Affordability and Quality

The impact of price controls on cancer treatment also featured prominently in the discussion. Dr Harit Kumar Chaturvedi, CEO and Clinical Head of the Oncology Network at Apollo Hospitals Group, said recent developments had underscored the need for the healthcare sector to engage more openly with the public about the costs of delivering treatment.

“Cost doesn’t mean high quality, and it should not go together as a symbol,” Chaturvedi said, calling for treatment quality to be assessed through objective measures rather than prices alone.

He highlighted patient-reported outcome measures (PROMs) and patient-reported experience measures (PREMs) as tools to help patients assess treatment outcomes and their experience of care.

Chaturvedi also flagged shortages of trained oncologists, pathologists and radiologists as barriers to expanding cancer services. He proposed digital platforms and structured referral networks linking hospitals across regions, enabling patients to access treatment closer to home while referring complex cases to specialised centres.

Insurance Gaps and Procurement Concerns

The discussion also highlighted gaps in financial protection against expensive treatments. Ankit Srivastava, Associate President for Employee Benefits at Howden Insurance Brokers India, questioned whether conventional health insurance was adequate when advanced cancer therapies could cost ₹25 lakh or more, against a typical insurance cover of ₹5 lakh.

Mandeep Singh Kumar, Managing Director and Vice President of Medtronic India Subcontinent Countries, meanwhile, criticised procurement systems that prioritise the lowest-priced eligible bidder under the L1 mechanism without sufficiently accounting for clinical effectiveness.

“For a long time, we have looked at cost effective, but the focus has always remained on cost. We just forgot about the effective part,” Kumar said, calling for procurement decisions to give greater weight to the clinical benefits of medical devices and technologies, rather than their initial purchase price alone.

Published on October 28, 2026

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