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Swasthya Sathi scheme health cover may turn conditional at Vellore

West Bengal government is considering making an approval necessary for a patient to avail of the state scheme at Christian Medical College

Sanjay Mandal | Published 08.04.22, 06:24 AM
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Representational image

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The state government is considering making an approval necessary for a patient to avail of Swasthya Sathi scheme at Christian Medical College, Vellore, which is flooded with patients from West Bengal, often with minor ailments, officials said on Thursday.

State health department sources said the government is also considering to prepare a list of ailments for which a patient can avail treatment facility under the Swasthya Sathi scheme.

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Every year, tens of thousands of patients from West Bengal go to CMC Vellore for treatment. The state government had approached the Vellore hospital to accept Swasthya Sathi patients. The deal was finalised and the hospital had started accepting patients under the scheme from January 2021. 

Swasthya Sathi, a medical insurance scheme launched by the West Bengal government for secondary and tertiary care, now covers more than two crore families in the state. 

Chandrima Bhattacharya, minister of state for health in West Bengal, said around 7,800 patients have been treated under Swasthya Sathi at CMC Vellore till date. “Many patients from our state go to CMC Vellore for treatment and so we had decided to tie up with the hospital,” said Bhattacharya.

CMC Vellore officials said in the financial year 2021-22, out of total 13,900 patients from West Bengal getting admitted at the hospital for treatment, 5,900, which is more than half, had availed the Swasthya Sathi scheme. 

“However, there are rejections of the claims under the scheme. The West Bengal government’s opinion is patients from the state should avail the scheme at the hospital only for critical diseases that need superspeciality treatment. Other common ailments can be treated at Bengal hospitals,” Prasad Mathews, medical superintendent of CMC Vellore told The Telegraph on Thursday.

He said about one third of the claims have been rejected by the West Bengal health department.

Mathews said reimbursements are given mostly for critical treatments like neurosurgery and cancer. “Claims for simple surgeries are also not given because these facilities are widely available in West Bengal hospitals,” said Mathews.

“In many cases we see family members accompanying the patient get themselves treated or examined for minor ailments. Such claims are usually rejected,” he said.

The Telegraph has reported on Thursday that the state government has engaged global consultancy firm EY (formerly Ernst & Young), to review the scheme after the private hospitals in Bengal expressed their resentments about the rates and delay in reimbursements.

 

The private hospitals have alleged that many of the rates offered under the scheme are unviable. Association of Hospitals of Eastern India, the body of private hospitals, has formally written to the state government about the resentments. 

Private hospital officials in Kolkata said the same policy of selective treatment under the health scheme should be allowed by the government at these healthcare facilities. 

“CMC, Vellore being a superspeciality hospital is allowed to treat only selective cases under the scheme which will not affect the financial health of the institute,” said Sudipta Mitra, chief executive of Peerless Hospital. “It will be helpful if the state government allows only critical care under the scheme at superspeciality hospitals in Kolkata while other cases  should be referred to smaller hospitals,” said Mitra.

Last updated on 08.04.22, 06:24 AM
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