The health department on Monday issued a series of advisories on Swasthya Sathi, including increasing the ceiling for medicines and diagnostic tests from Rs 5,000 to Rs 25,000, a move that many say will reduce instances of refusal to admit patients under the scheme.
An official of a private hospital said that under the scheme a private healthcare facility was entitled to receive Rs 3,300 each day for the medical management of a patient.
That apart, private hospitals are entitled to an additional Rs 5,000 for diagnostic tests and expensive medicines for critical patients per incidence. An official of a private hospital said “per incidence” mean teach time a patient requires a medicine or undergoes a test.
The advisory issued by the state health department on Monday said the upper limit for the additional expense on diagnostic tests and medicines would be increased to Rs 25,000.
The advisory reads: “Competent authority has decided to increase the ceiling limit of Medicine and Diagnostic Costs for Private Hospitals having final NABH accreditation up to Rs 25,000 subject to proper scrutiny and verification.”
The increase will be applicable to hospitals that have the final accreditation from the National Accreditation Board for Hospitals and Healthcare Providers.
An MRI costs about Rs 8,000, a CT scan costs about Rs 3,000. Besides, there are expensive medicines like Meropenem which are not within the cost bracket allowed earlier under Swasthya Sathi, the official said.
The official said the increase would reduce instances of refusal by private hospitals to admit patients under the scheme. Private hospitals often complained that the limit allowed by Swastha Sathi was too low for them to admit patients under the scheme and yet remain sustainable.
With the ceiling raised, private hospitals are expected to admit more patients under the scheme.
Rupak Barua, president of the Association for Hospitals in Eastern India, welcomed the move.
“The earlier rate was too low and rather unscientific, without taking into consideration the ground realities. Even small nursing homes were notable to deliver proper treatment at the old rates,” said Barua, group CEO of AMRI Hospitals.
“We hope the government will take another look at the other package rates as well under Swasthya Sathi and revise those in accordance with the rising cost of medicines and the latest healthcare technologies necessary for medical management of patients.”
Another advisory bars all private hospitals in Murshidabad Sadar and Malda Sadar sub-division areas from admitting any orthopaedic patients under the scheme directly, except in emergency cases.
The hospitals can admit patients requiring planned procedures only if a certificate stating that the treatment is not available at Murshidabad Government Medical College and Malda Government Medical College is obtained.
Another advisory is about the release of pending payment for treatment to government hospitals.
It reads: “All the cardiology and orthopaedic cases done by the government hospitals and medical colleges under Swasthya Sathi, the actual implant cost involved in such treatment packages will be reimbursed to them, henceforth, subject to the condition that implants used in treatment packages”.
Many such claims are pending, the advisory says.