Private hospitals have to treat emergency orthopaedic cases under the Swasthya Sathi scheme, says an advisory issued by the state health department. Patients who have suffered fractures in an accident should be considered as “emergency” cases if they are admitted to a private hospital within 48 hours from the time of accident and can provide necessary legal documents, the advisory says.
The advisory, issued recently, follows another issued on November 1 that said all cold — non-emergency — orthopaedic cases should be treated at private hospitals under Swasthya Sathi only if a government hospital was unable to treat the conditions.
“We have received several complaints from patients and relatives that some private hospitals and nursing homes are refusing to treat emergency orthopaedic cases under Swasthya Sathi on the ground that those are not included in the scheme. Emergency cases have to be treated by hospitals,” a senior official in the state health department said on Tuesday.
Health department sources said some nursing homes were treating cold orthopaedic cases but showing them as emergency cases.
“All emergency orthopaedic cases can be performed in private hospitals where orthopaedic surgeons are available as registered practitioner for that particular hospital as per updated information in Swasthya Sathi portal,” the latest advisory says.
“Any accidental fracture of bone if admitted within 48 hours from the time of occurrence and supported by all legal documents as per existing norms should be considered as emergency cases.”
On November 1, the health department had issued an advisory saying cold orthopaedic cases could be handled at private hospitals under the scheme only if a nearby government hospital, not below the level of sub-divisional hospital, certified that the condition could not be treated there.
The November advisory was issued because the health department felt that though the infrastructure and personnel strength at government hospitals had been upgraded, the facilities were not being utilised and patients were being unnecessarily referred to private healthcare institutes.
“However, in an attempt to prevent such diversions, another problem cropped up. A section of private hospitals started refusing Swasthya Sathi patients even if they are accident victims,” said the health department official.
The Telegraph had earlier reported that many hospitals and doctors were reluctant to treat Swasthya Sathi patients because of lower rates the government has fixed for beneficiaries of the scheme.
“Also, some smaller hospitals and nursing homes are continuing to treat cold orthopaedic cases by tweaking the reports and making them look like an emergency. Now, they have to submit legal documents like police reports about the accident to get reimbursement,” the official said.
According to officials, around 7,000 patients are admitted daily in private hospitals under Swasthya Sathi.
“The government has spent around Rs 9,000 crore in reimbursements under the scheme,” said an official in the health department. He said that in the last fiscal, the government had spent Rs 2,600 crore. The expenses in the current financial year would be similar.
The official said the IT system for the scheme had also been upgraded for better detection of fraud and errors using artificial intelligence.
“Often, patients are not discharged on time. One surgery is performed but another is mentioned in the records. These will be detected better by the new system,” he said.