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Resource centre on India's rural distress
 
 

Health plan hits rough weather -Pranesh Sarkar
-The Telegraph


Kolkata: The Bengal government's decision to select insurance companies quoting the lowest premiums for a centrally funded health care scheme has hit private hospitals that are refusing patients citing non-payment of claims by the firms.

Senior officials of the health department said thousands of poor patients registered under the Rashtriya Swasthya Bima Yojana were being refused admission by hospitals and nursing homes across the state every month. The registered families fall in the BPL category and are supposed to get medical coverage of up to Rs 30,000 each.

"A recent report prepared by the district administration of Murshidabad has revealed that about 2,500 patients in the district were being refused by hospitals every month. Till last year, around 4,000 patients in the district used to get free treatment every month. The figure has come down to 1,500 these days," a health department official said.

Sources said the insurance company handling the scheme in Murshidabad owed at least Rs 7 crore to around 40 hospitals. Claims submitted by private health care facilities are usually settled in a month, they added.

"The picture is the same everywhere. Around 300 nursing homes and hospitals registered under the scheme are facing problems getting their claims cleared," a senior health department official said.

Pankaj Chowdhury, the owner of a private health care facility on the outskirts of Behrampore town, said an insurance company owed him about Rs 1 crore since April this year. "We are being forced to refuse patients. But we have admitted some on humanitarian grounds."

According to the scheme, in which the Centre bears 75 per cent of the premium and the state shoulders the remaining 25 per cent, a BPL family of five members or less can be registered against a yearly payment of Rs 30. Each family gets a medical coverage of Rs 30,000 a year.

Till last year, the scheme, launched in 2010-2011, was handled by the labour department. The health department took over this year.

A Nabbana official said: "The problem with the scheme in Bengal is the government's decision to select insurance companies quoting the lowest premium rate."

The viability of the scheme took the hit as the insurance companies lowered their quoting rates to undercut competitors and grab the government tender.

"The problem started after the health department insisted on reducing the premium," an official said.

So the premium for each card-holder dropped from Rs 460 last year to a band of Rs 190-Rs 225.

"The amount quoted by the companies was unrealistic. In the first three years of the scheme, companies had to clear 100 per cent of the claims in some districts against a premium of Rs 460. How is it possible with the reduced amount?" an official asked.

Senior government officials said another criterion ignored by the health department was the third party administrator - who settles claims on behalf of the agencies.

"Now, there have been complaints that the TPAs are urging the nursing homes against submitting claims. They are telling the hospitals not to pressurise the companies further as they are already burdened with dues. So the hospitals are refusing patients to escape the trouble," an official said.

An official of National Insurance Company, which handles the scheme in eight districts, admitted bills were pending. He, however, refused to elaborate why there was a delay.

ADDITIONAL REPORTING BY ALAMGIR HOSSAIN AND AMIT UKIL