Public hospitals’ share of claims up in insurance scheme

Government hospitals are being actively wooed under the new Chief Minister’s Comprehensive Insurance Scheme, launched in January this year. As a result, there has been a quantum increase in the State’s share of the total amount claimed.

In the scheme that preceded this version, introduced during the Dravida Munnetra Kazhagam’s rule, government hospitals’ claims totalled only one percentage of all settlements. Now, after seven months of implementation under the new scheme, the public hospitals’ share has shot up to 30 per cent. Government hospitals have done 41,797 cases and realised claims totalling Rs. 94,54,35,100.

Sources say the idea, as was mentioned in the initial statement of the Chief Minister, was to ensure that patronage is extended to government hospitals as well.

Going by the figures, the earlier scheme saw a lot of beneficiaries going to private sector hospitals to get surgeries done. “But there are government super-specialty hospitals with the same skill sets and facilities. Those would have to be utilised too under the health insurance scheme. That was the mandate,” according to an official.

Special wards

In preparation, special wards were set up in all the tertiary-teaching hospitals, district headquarters hospitals and certain taluk hospitals, to specifically serve patients under this scheme.

Patients who required procedures and who were eligible under the CM’s Insurance Scheme (see graphic for eligibility criteria) were referred to these special wards where they received treatment. Across the State, about 1,000 beds have been allotted in various government hospitals under the scheme.

The insurance claim would then be made by the hospital at special rates marked for each procedure.

Grading scheme

A grading scheme marks the rate each hospital can charge for a particular procedure, thereby claim amounts can vary from hospital to hospital for the same surgery.

Institutions are rated from A1 to A6, with A1 at the top of the pile, receiving 100 per cent insurance claim.

Currently, all government hospitals have been rated as A1, again as part of efforts to actively woo the public sector hospitals.

A total of 1,016 procedures are being covered under the new scheme.

All diagnostic procedures

In addition, all diagnostic procedures, whether the results indicate treatment or not, are being covered, while earlier only those diagnostic reports that indicated treatment were covered.

Periodic follow-ups are covered under the package, and patients compensated for transportation charges incurred in accessing treatment. The procedures are completely cashless for patients, whether in the private or public sector.

They have handled 41,797 cases and realised claims totalling Rs. 94,54,35,100

A total of 1,016 procedures are being covered under the new scheme