BENGALURU: Come April 1, the government plans to introduce a system where a referral letter from a government hospital will be needed for patients to avail treatment at a private hospital. The referral letter must say that the government hospital does not have the facilities to treat the patient and hence, the private hospital should treat him/her.
Only then will the government pay for the treatment under various government medical insurance schemes. This includes schemes meant for below poverty line patients, above poverty line patients, and government staff and dependents.
This decision essentially renders government medical insurance ineffective. The entire point of having medical insurance schemes is to give an opportunity to the poor to get treatment in good healthcare facilities. This decision comes after private tertiary care hospitals in the state, around 166 of them stopped treating patients after mounting dues from the government.
This decision also comes in the wake of private hospitals empanelled with SAST (Suvarna Arogya Suraksha Trust which runs the schemes on behalf of the government) alleging that these schemes are not benefiting the actual BPL families but those with fake BPL cards. These schemes gave a chance for the poor to get treatment in super specialty hospitals at no cost. Now, the government expects 20 tertiary care hospitals to shoulder the burden of what 150-plus hospitals did.
Principal Secretary to the Health Department Shalini Rajneesh, said, “Since renewal of MoU is due with hospitals on March 31st we plan to include the revised process for sending pre-authorisation with referral letter from government facility for tertiary care.”
If beneficiaries thronging 166 private tertiary hospitals currently were to go to the 20 government tertiary care hospitals first, this would phenomenally increase the burden on these hospitals. Also, the freedom of choice of the patient on where he/she desires to be treated will be taken away. Asked about these concerns Rajneesh, said, “We will take all this into account and work out a patient centric model.” She also added that this is one of the several changes being planned by the government which will be finalised soon.
There is no other state in the country where such a government diktat exists that one should go to a government hospital first in order to get the government pay for medical treatment to the poor. This defeats the purpose of providing subsidy to the poor.
Express looked at Tamil Nadu, Kerala, Andhra Pradesh, Telangana, Odisha and Gujarat on how medical insurance schemes are implemented. For one, Odisha has collaborated with a private medical insurance company that pays for BPL cardholders. There is no third party administration who is involved in providing these schemes in Karnataka.