New prescription for Karunya may add to confusion

Health Department has brought out guidelines on how to apply for treatment and how to process requests to resolve the uncertainties

July 21, 2019 12:18 am | Updated 12:18 am IST - Thiiruvananthapuram

In an effort to resolve the uncertainties surrounding the provision of medical treatment at Karunya Arogya Suraksha Paddhati (KASP) rates to the beneficiaries of the erstwhile Karunya Benevolent Fund (KBF), the Health Department has now brought out guidelines on how to apply for treatment and how to process requests.

The guidelines have been issued in support of the recent government order by the Health Department, which states that all those eligible for KBF but are not current Rashtriya Swasthya Bima Yojana (RSBY) or KASP card-holders, will “continue to get treatment benefits in all empanelled hospitals for catastrophic illnesses as per the KASP packages for the current financial year.”

However, the stage is being set for more confusion and conflicts between hospitals and patients seeking free treatment as well as more complaints of treatment denial by hospitals because running KBF alongside KASP platform is easier said than done. When the decision last year to launch KASP as an integrated health protection scheme by merging KBF and RSBY-CHIS schemes was taken, the government knew that a certain proportion of the population in the bottom rung of the APL (above poverty line) category, who were eligible for KBF but would not be eligible for KASP coverage, would be left in limbo once KBF was stopped.

However, while these people still had the option to join KASP, by paying the annual premium amount of ₹1,671 on their own, the small community of haemophiliacs and renal transplant patients who were dependent on KBF dole for their regular supply of expensive medications were totally left in the lurch. KASP covered day procedures like dialysis but not these drugs.

“The initial plan had been that the Health Department would initiate a special scheme for these patients. The number of haemophiliacs registered under KBF is specific (1200 plus) and Kerala Medical Services Corporation Limited (KMSCL) is currently spending around ₹30 crore annually for their medicine, which these patients were being given free of cost through Karunya outlets. That system could still continue. It is the total lack of preparation and foresightedness on the part of the Health Department in handling the transition phase issues which has precipitated the current confusion,” a senior Health official said.

Free treatment

The government is now asking public and private hospitals empanelled under KASP to give free treatment to KBF beneficiaries, with the promise of reimbursement. Major public sector hospitals that are facing serious financial crises because of huge insurance claims dues under the former RSBY may find this an additional burden.

“The current scene of treatment first and payment later may not work at all because hospitals are already hard up and have huge pending payments due to them as insurance claims and previous KBF arrears,” a public health professional pointed out. Now that KBF has been stopped, Lotteries Department officials are no longer available for verification of KBF eligibility or the pre-authorisation of treatment procedures.

The entire onus of verification of eligibility, pre-authorisation as per KASP rates and patient’s KBF account monitoring has now been put on the District Project Managers (DPM) of CHIAK, as per the Health Department’s guidelines. DPMs are contract staff and there could be issues of accountability and audit issues in future.

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