The Rashtriya Swasthya Bima Yojana (RSBY), or Comprehensive Health Insurance Scheme, which gives a annual health expense coverage of up to Rs.30,000 a family, may have proved to be a windfall for many government hospitals. But for the medical college hospitals giving tertiary-level medical care, the scheme has not been rewarding, say administrative officials of the hospital here.
With extended paperwork and the struggle for hospitals to balance the huge claim amounts and equally huge expenditure statements, the scheme has become more of a burden for many tertiary-care hospitals, they say.
“[The] RSBY may be profitable for most public sector hospitals as the actual expenditure is low and the flow-backs of insurance payments can be considered their ‘profits.' However, for the MCH [Medical College Hospital] here, which does a lot of high-end procedures, the expenditure is too high to rake in such ‘profits,'” a hospital official says.
Under the scheme, the hospitals can utilise the insurance payments that come to it for improving infrastructure. The government has prepared a list of over 700 medical and surgical interventions and procedures along with fixed rates. The in-patient (IP) charges that a hospital can claim for a patient is Rs.500 a day.
The patient may be entitled to a total treatment expense of up to Rs.30,000, but for the procedures done, the hospitals will not get more than the fixed rate. The actual expenditure for a procedure may exceed that.
Medical college authorities point out that the rates fixed are the same for all hospitals, right from primary health centres to the medical colleges. The scheme is just not viable for hospitals offering tertiary-care services. Separate rates should be fixed for these institutions, they say.
Not covered
The medical college hospitals claim that several high-end procedures are not covered under the scheme or the rates fixed are barely enough to cover the actual expenditure. Orthopaedic implants, for example, are very costly, which the hospital authorities are expected to purchase and provide for the patient, though the rates fixed for these are very low. The system is cashless; so, it becomes the hospital's responsibility to treat the patient, incurring expenditure on its own.
“The maximum amount the hospital can claim for treating brain aneurysm may be about Rs.12,000, while the aneurysm stapler we have to purchase for the treatment alone costs Rs.10,000. The IP charges of Rs.500 a day for a patient does not cover the expensive drugs that we often have to purchase from shops outside for a patient,” a senior doctor says.
In the past seven months, the medical college hospital here treated 2,049 patients under the scheme. The total claim that it has put up is Rs.1.183 crore while the actual expenditure is about Rs.96 lakh. “There are reports that some government hospitals such as the Chertala taluk hospital has raked in RSBY funds to the tune of Rs.1.5 crore, while our RSBY funds now is a meagre Rs.22 lakh,” he says.
The medical college hospitals also have to contend with delays in insurance payments. The hospital here has received only about Rs.71 lakh of its claim and it would be months before the rest of the payments comes in.
The government hospitals, including the medical college hospitals, used to have the services of additional doctors and paramedical staff appointed on contract by the National Rural Health Mission (NRHM). With the mission trying to streamline its funds utilisation, the hospitals are now expected to meet the salary expenses from the RSBY funds.
However, this has proved too tough for the medical college hospital here. Services of 36 additional nurses and six lab technicians from the NRHM had to be given up, resulting in an acute staff shortage.
