West Bengal government’s flagship free healthcare scheme, Swasthya Sathi, has run-up dues of ₹150-200 crore to various private hospitals, some of which are mulling legal action to recover dues.
The Swasthya Sathi scheme announced in 2017 now covers 2.5 crore families with the West Bengal government offering basic health cover of ₹ 5 lakh a year for each family for secondary and tertiary care.
This obviously has led to pressure on hospital infrastructure, especially with most healthcare providers allocating nearly 15 per cent of their beds for the healthcare scheme, said an industry source. To top it all, treatment is cashless, so a hospital has to send bills for clearance to the State Health Department.
The reimbursement cycle, which was earlier close to 15-20 days, has now got extended to 45-50 days. A number of hospitals are therefore finding it difficult to continue accepting patients under the scheme, another source said. A senior Health Department official confirmed that there is a “15-day running cycle at any given point of time with the actual monthly outflow towards payment being earmarked at ₹200 crore.”
“So in that sense a ₹100-150 crore dues from the State government at any given point of time will be in that range,” the official said.
However, Chandrima Bhattacharya, Minister of State for Health, maintains that the scheme is working fine. “The scheme has not fallen apart. And many people are benefitting from it. It should not bother anyone if we have an insurance partner or not. We are also dealing with refusals of patients by hospitals through appropriate measures,” she told BusinessLine.
According to Rupak Barua, CEO, AMRI Hospitals Ltd and president of Association of Hospitals of Eastern India (AHEI), the cost structure and bed charges prescribed by the State’s health scheme is not acceptable by most hospitals. The rates are too low even for small nursing homes.
For instance, the average daily ICU charges work out to ₹40,000-45,000 in a private hospital. However, the State government scheme provides for ₹7,000-10,000.
‘No insurance partners’
“We have appealed to the State government to review the cost structure, particularly bed charges and other charges they have stipulated for medical management. It is difficult for private hospitals to operate at this kind of cost structure,” he said.
Besides, the State government also does not have insurance partners in the scheme since June 2021 as the companies exited due to low premium rates. The scheme is now on an assurance model where the State government directly clears dues of hospital.
In 2017, the National Insurance Company was insurance partner in nine districts and United India Insurance Company in 11 districts.
Thereafter in 2018, Bajaj Allianz was selected as insurance partner in 18 districts and IFFCO TOKYO was selected for five districts. In 2020 again National Insurance Company was selected as insurance partner in six districts, Oriental Insurance in nine and United India Insurance in eight districts. The Hindu BusinessLine