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All is not well with this insurance scheme

Uncleared bills, delay in software installation stymie Rashtriya Swasthya Bima Yojana

THE Union government’s ambitious medical insurance scheme for the poor — Rashtriya Swasthya Bima Yojana (RSBY) — launched in five districts in Karnataka on a pilot basis last year, is all set to be expanded to the entire State.

But before moving ahead with its plans, the State Labour department may do well to clear dues and address other issues relating to the Yojana.

According to a study conducted by the Centre for Decentralisation and Development, the Institute for Social and Economic Change (ISEC) last year, many hospitals covered under the Yojana complained of delay in reimbursement of the bills.

Deccan Herald got in touch with 10 hospitals in Dakshina Kannada, Shimoga, Belgaum, Mysore and Bangalore Rural districts and found that these hospitals had accumulated unpaid bills for at least six months. Owing to delay in the reimbursement of bills, some hospitals are even rethinking their decision to join the scheme this year.
Low tariff

“We have treated as many as 60 patients so far, but have received reimbursement for only 20 patients. Even the per-day treatment tariff, fixed at Rs 500, is low,” said a doctor at Sri Rama Hospital, Doddaballapur.

The J G Co-operation Hospital and Research Institute, Belgaum, is also yet to receive payments to the tune of about Rs 3.6 lakh, pending since October last year. The delay in reimbursement of bills has also been reported in Dakshina Kannada district.

Besides treating patients from Karnataka, the hospitals have a large flow of patients from Kerala, too. “About 60 per cent of our RSBY patients are from Kerala. While we received payment for Karnataka patients, amounting to Rs 11 lakh in March, we are yet to receive reimbursement for the Kerala patients,” said the administrator of Father Muller 
Charitable Hospital, Mangalore. The hospital has unpaid dues to the tune of Rs 33 lakh since June last.

Other empanelled hospitals in the district also face the same problem. “We are not willing to take patients from Kerala since bills amounting to Rs 26 lakh are yet to be cleared. We raised the matter with the assistant labour commissioner here. But it has failed to yield any results,” said the administrator of the Justice K S Hegde Charitable Hospital.

Software problem
Hospitals also face technical hurdles in the form of delay in the installation of the software, or its improper installation. “We had to turn down several patients as the software refused to accept their smartcards. The machine would not read their card and enter them in the system,” said a doctor from KGP Hospital, Shimoga.

“Instead of launching more such medical insurance schemes, the government should go in for National Rural Health Guarantee Act, similar to the National Rural Employment Guarantee Act (NREGA),” said Dr Avinash Nanjappa of Nanjappa Hospital, Shimoga. The hospital is awaiting reimbursement of about Rs 50,000.

About RSBY
The RSBY provides medical cover for families below the poverty line (BPL), which includes hospitalisation, out-patient treatment and surgical treatment in select hospitals.

The medical insurance provides an annual cover of Rs 30,000 per household and covers five members of a family. Even transport allowance up to Rs 1,000 a year is given to the 
BPL families. 

The BPL families are given smartcards and they have to spend Rs 30 as annual 
registration fee.

Number of claims

Districts    No of BPL families     No of     Amount
(estimated)         claims    (till Mar 2011)

Mysore    49,287    1,288    Rs 72,49,200
Shimoga    18,244    258    Rs 11,96,476
Bangalore Rural    12,645    332    Rs 12,39,982
Belgaum    52,995    453    Rs 18,85,350
Dakshina Kannada    24,234    1,067    Rs 63,39,295

(Published in Deccan Herald on 17th May, 2011)

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