Online referral of patients from a government hospital to an empanelled higher facility for secondary and tertiary treatment under Ayushman Bharat Arogya Karnataka (AB-ArK) scheme has gained momentum. Over two lakh patients have been referred online since June 2022, when the system was introduced in Karnataka, till July 2024..
Karnataka was the first State to implement the online referral system (ORS) in India. The National Health Authority (NHA) — the central agency implementing the health scheme — had recognised the module as one of the ‘best practices’ in the country.
The health scheme covers 1,650 procedures — 294 simple secondary, 251 complex secondary, 934 tertiary care procedures and 171 emergency procedures. While the simple secondary procedures are completely handled at the government hospital level, for all other procedures, patients need to be referred by a government hospital to a higher facility (including empanelled private hospitals) if the former is not equipped to treat the illness. The scheme offers cashless treatment up to ₹5 lakh a year per family.
Year-wise online referrals (June 2022 to July 2024)
| Year | Patients |
| 2022-23 | 35,238 |
| 2023-24 | 1,24,488 |
| 2024-25 (till July) | 46,349 |
| Total | 2,06,075 |
Facility-wise referrals
| health facility | Referrals (%) |
| District hospitals | 33.3 |
| Medical college hospitals | 14.1 |
| Taluk hospitals | 52.1 |
The manual process, used for referral prior to June 2022, involved filling out a pre-printed form. The old process was time consuming for doctors and also caused inconvenience to patients. Besides, there were complaints of malpractices, wherein some patients used influence to get referred to a hospital of their choice although the government hospital had the capability to treat them.
BPL card holders
According to data from Suvarna Arogya Suraksha Trust (SAST), the nodal agency that implements the State’s health scheme, over 97% of the beneficiaries of online referrals are BPL card holders. Over 33% of the total 2.06 lakh online referrals have been made from district hospitals. While 52.1% of the online referrals are from taluk hospitals, 14.1% are from medical college hospitals.
A look at speciality-wise online referrals revealed that the highest number of online referrals were related to urology (18.6%) followed by medical oncology (12.4%). Less than 1% of the online referrals made were related to interventional neuroradiology, pulmonology, accidents and polytrauma, plastic and reconstructive surgery, mental health disorders, burns, surgical gastroenterology, dental, oral and maxillofacial surgery, general medicine and cardiovascular surgery.
While hospitals in Belagavi have made the highest number of online referrals under the scheme, followed by Bagalkot, Davangere, Dakshina Kannada, Vijayapura and Mysuru. The lowest referrals have been made by hospitals in Kodagu followed by Dharwad, Ramanagara, Chikkaballapur, Hassan and Bidar.
Former State Health Commissioner Randeep D. (who was transferred recently) said the online referral system is not only to ensure timely treatment for patients but also to usher in transparency, avoid malpractices and unnecessary referrals, “The objective of this module is to help identify hospitals where the patients could go to, and prevent unnecessary referrals and an unhealthy nexus of the government and private institutions,” he told The Hindu.
Pointing out that the World Health Organisation (WHO) is also studying this module for replicating elsewhere, the Commissioner said Karnataka is working on further improvements by linking the Online Referral Module to SAST portal, providing online access and view facility to patients.
How does the online referral system work?
The system searches for availability of specialities in the public health institutions (PHIs) of respective districts. If the speciality is available, it will refer the patient to the PHI. If there is no availability, the system provides a list of empanelled hospitals in ascending order of proximity for beneficiaries. The patient can go to a hospital of their choice. However, this is not provided digitally. Sources said there should be end-to-end digitisation of the online referral process.
Published - September 05, 2024 10:45 am IST
