The West Bengal government has engaged global consultancy firm EY to review its Swasthya Sathi scheme, an official said on Wednesday.
Swasthya Sathi, a medical insurance scheme launched by the government for secondary and tertiary care, had triggered resentment among private hospitals in Bengal, which alleged that some rates under the scheme were unviable. The hospitals had also alleged late payment under the scheme.
“We have appointed EY (formerly Ernst & Young) to review the scheme. The firm will submit its recommendations on possible modifications required so that the scheme becomes more acceptable to service providers and beneficiaries,” said an official of the state government.
The Telegraph spoke to hospitals and officials of the health department to find out the problem areas
Swasthya Sathi has become extremely popular and private healthcare institutes are flooded with patients under the scheme. According to the Swasthya Sathi website, more than 2 crore families are covered by the scheme. The state’s health regulatory commission is receiving complaints that hospitals are refusing to treat patients under the scheme.
The relative of a patient, who requested anonymity because the person is still undergoing treatment at a hospital in Kolkata, said that initially when they had gone to see a doctor for a problem in the brain, the hospital’s staff at the help desk said no doctor was available to examine patients enrolled with Swasthya Sathi.
“We went back after a few days and were told that all beds under the scheme were occupied,” said the family member. The patient, he said, was admitted following intervention of a political leader.
“We get complaints about refusal. We have a zero-tolerance policy in this regard,” said retired judge Ashim Banerjee, chairperson of the West Bengal Clinical Establishment Regulatory Commission.
“However, at times there are genuinely no beds available because the scheme is very popular.”
Recently, an elderly patient wanted to get admitted to a private hospital in Kolkata. The person was denied admission because the thumb impression did not match the sample in Swasthya Bhavan’s database, said an official in the health department.
The patient was finally admitted after the commission’s chairman intervened.
Reasons for refusals
Private hospitals said that the number of people seeking admission under the scheme was much more than the beds earmarked for such patients.
“According to the agreement with the state health department, 15 per cent of the beds at a hospital have to be earmarked for patients covered by the Swasthya Sathi and West Bengal Health Services schemes. Most hospitals have many more patients under the scheme,” said Rupak Barua, president of the Association of Hospitals of Eastern India and group CEO, AMRI Hospitals.
He said 120 patients were currently admitted to the three units of AMRI — in Dhakuria, Mukundapur and Salt Lake — under the two schemes, compared with the 70 beds reserved at the hospitals for such patients.
Another reason cited by hospitals is the “unviable rates” — in some cases less than 25 per cent of the rates offered by insurance companies.
Barua said: “The per-day reimbursement for a patient admitted in a critical care unit is Rs 3,300. Some additional payment is allowed for a group of expensive drugs. However, the average cost for a patient on a ventilator is around Rs 25,000 every day.”