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Swasthya Sathi rate revision, ‘Rs 125 cr’ dues: 16 Kolkata pvt hospitals’ demands to Mamata govt

In letter to state health secretary, hospitals have raised issues they're facing under state health insurance scheme launched by Mamata Banerjee's TMC govt in 2016.

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Kolkata: Sixteen private hospitals in Kolkata have written to West Bengal Health Secretary Narayan Swaroop Nigam, seeking a revision in rate of treatment offered under the government’s Swasthya Sathi scheme, ThePrint has learnt. The hospitals have also demanded release of crores of rupees in backlog payments for treatments provided under it.

Introduced in December 2016, the Swasthya Sathi scheme offers basic health cover for secondary and tertiary care for up to Rs 5 lakh per annum per family. A smartcard is issued, in the name of the woman of the family, which allows for cashless treatment, paid for by the government. Private hospitals are required to charge subsidised rates for treatment under the scheme.

“We would like to point out that without a rate revision, it would become increasingly difficult for us to admit patients under the scheme,” said the letter by the hospitals dated 11 March, and addressed by the representative body, Association of Hospitals of Eastern India. The letter also claimed that the last rate revision for treatment under the scheme had happened three years back.

Hospitals which have sent the joint letter include AMRI, Woodlands, Apollo, ILS, Narayana, Medica, Peerless, Ruby, Belle Vue, Fortis, Kothari Medical, Bhagirathi Neotia Women & Child Care, Charnock, Sri Aurobindo Seva Kendra, and Mission of Mercy. These are among top healthcare facilities in Kolkata.

ThePrint has accessed the two-page letter, which mentions the benefits of the healthcare scheme for people in the state, but also raises difficulties being faced by private hospitals in providing treatment under it.

“We had mutually agreed that the payments would be made within 20 days of submission of necessary documents. We would like to your attention that unfortunately, there has been prolonged delay in reimbursing bills of patients under Swasthya Sathi scheme,” the letter states.

The hospitals claimed that payments by the government for patients treated under the scheme were taking as long as 60-90 days and that “the accumulated amount has become sizeable, making it difficult to admit more patients under the scheme”.

ThePrint reached three of the signatory hospitals over WhatsApp, but while AMRI and Woodlands refused to comment, no response was received from Narayana Hospital till the time of publication of this report.

A source in one of the signatory hospitals, however, claimed on the condition of anonymity that total backlog dues, across hospitals, amount to around Rs 125-130 crore.

ThePrint also reached state Health Secretary Nigam for a comment on the dues, but he said, “I don’t have the data now”. On the letter, he said, “We are talking to them, and all payment issues will be resolved.”

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‘Pvt hospitals severely underprovided for’

When launched in December 2016, the Swasthya Sathi healthcare scheme was meant to benefit those in the state who were below the poverty line and was seen as a direct counter to the Centre’s Ayushman Bharat scheme, which the West Bengal government doesn’t subscribe to.

Four years later, in December 2020, however, benefits of the scheme were extended to cover every household in West Bengal. The move came months before last year’s assembly elections in the state. The extension of the scheme has increased the burden on private hospitals, pointed out the letter, with the number of patients admitted under the scheme having “increased exponentially”.

While rolling out the scheme, West Bengal Chief Minister Mamata Banerjee had said the state will bear an annual expense of Rs 2,000 crore under the scheme. During the West Bengal budget session last week, the government claimed that around 24.85 lakh beneficiaries have availed the Swasthya Sathi scheme since its inception in 2016. With 2.2 crore families enrolled under this health scheme, the state government claimed it had spent Rs 3,212.72 crore on it.

But medical experts in the state claim private hospitals are “severely underprovided-for” under the scheme.

“For example, if general surgery, the most common procedure, cost Rs 30,000 at a nursing home, under this scheme the state has brought the rate down to Rs 10,000,” said Kunal Sarkar, cardiac surgeon at Medica, one of the signatory hospitals.

“This scheme has been a flawed process, the mathematics is diabolical, and was introduced only for short term political gains. No way can the West Bengal government meet these figures unless they allocate six per cent of the total GDP to healthcare, the allocation is currently somewhere around 3 per cent,” he claimed.

“The only solution I see is that ethically the state admits that it isn’t possible to provide free healthcare to such a large population and restricts the beneficiaries or subscribe to the Ayushmann Bharat scheme and take the money that has been earmarked for the state. Else, the last option is hospitals will bill the extra amount from the patients, if the state decides to look away,” Sarkar added.

On Monday, the West Bengal Doctors Forum too wrote a letter to the health secretary, stating delayed payments by the state under the Swasthya Sathi scheme are leading to delayed salary payments for doctors, impacting their families.

“Medical practitioners in private sector are being forced to work at an abysmally lower remuneration as fixed by Swasthya Sathi scheme which reduces the doctor’s earnings to a negligible quantity,” reads the letter accessed by ThePrint.

Meanwhile, even after 11 days of the private hospitals writing to the state on Swasthya Sathi issues, the source quoted above said no response has been received from the health department yet. As a next step, said the source, hospitals are now planning to meet the health secretary to discuss the problems they are facing.

(Edited by Poulomi Banerjee)

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