THIRUVANANTHAPURAM: A token system is being planned to manage requests for assistance from the special fund for ‘catastrophic illnesses’ under the Medisep health insurance programme for employees and pensioners. The need for the system arose due to an overwhelming demand for knee joint replacements, which were disproportionately sanctioned from the fund.
The special fund, which has a corpus of Rs 35 crore, was created to support severe illnesses that require prolonged treatment and expensive procedures such as kidney or liver transplantation, cardiac surgery, bone marrow transplantation, as well as knee joint and hip replacements.
However, the Rs 35 crore corpus set aside for three years was exhausted within eight months due to a spend of Rs 30.55 crore on 1,624 claims for knee joint replacements and Rs 2 crore on 115 claims for hip replacements. An amount of Rs 3.69 crore was spent on 40 liver transplantation cases.
To ensure a more equitable distribution of aid, the government restricted knee joint and hip replacement surgeries to government hospitals and promised to contribute Rs 3 crore to the fund every month with sanctions capped.
To manage requests for assistance, a token system will be introduced, with tokens issued for all cases reported by hospitals. “Tokens will be issued for all cases reported by hospitals and elective surgeries would be sanctioned first come first served. Requests on elective procedures will be sanctioned towards the end of the month so that serious patients get assistance in time. Token system will bring more control and transparency to the fund,” the source said.
Pre-authorisation from the government is not required to access aid from the special fund. The new system is expected to be implemented in a week.
The Medisep health insurance programme covers 29.92 lakh people, including beneficiaries and dependents, and has 479 participating hospitals, including 323 private hospitals and 143 in the public sector.