'Most Swasthya Sathi refusal cases reported against top pvt hosps in city'

KOLKATA: Swasthya Sathi related issues and refusals of patients are mostly being reported from the city-based private hospitals, which belong to the Category-A, but in case of the district hospitals there is hardly any such case found. Small-scale nursing homes and private hospitals from the districts are more dedicated to provide Swasthya Sathi treatment while the top hospitals prefer corporate patients over Swasthya Sathi beneficiaries to make more profit, said a senior Health official.

State government has already warned those hospitals where refusal cases occurred in recent times. There have been one or two incidents in which the district hospitals had submitted bogus bills of the patients, who were never treated in the hospital. This was done by some hospitals to make some money out of the scheme. State Health department has taken stern action against these private hospitals.

The West Bengal Clinical Establishment Regulatory Commission (WBCERC), the regulatory authority, has also taken serious cognizance of multiple allegations against a number of top private hospitals in the city.

On a number of occasions, the Commission has penalised many hospitals. "A mass health insurance scheme like Swasthya Sathi is mainly focused on the districts. Swasthya Sathi related complaints from the district hospitals are less. Problems persist with the Kolkata based hospitals. These hospitals make more profit out of corporate patients and hence they prefer corporate patients over Swasthya Sathi beneficiaries. Government does not pay for cabin, private wards as a result they refuse Swasthya Sathi patients when there are no general beds. Swasthya Sathi package is general bed oriented," a senior Health official said.

State government pays around Rs 1500 for general beds per day and in case of ICU the government pays around Rs 3,300 per day for each patient.

The private hospitals have, however, been seeking a revision in the fees structure.

The WBCERC has already published Whatsapp numbers and toll free numbers so that the people can directly call at these numbers and raise complaints if the hospitals refuse admission to Swasthya Sathi card holders.

The family members can lodge complaints from the hospital itself. The numbers are 9073313211/9513108383/8334902900. The toll free number is 1800345-5384 and it has been made operational.

More than 2.30 crore families have been included under the scheme and 2,290 hospitals have been empanelled. The scheme was announced on February 25 in 2016 and officially launched by the Chief Minister on December 30 in 2016. Basic health cover for secondary and tertiary care is up to Rs 5 lakh per annum per family.

Around 2.5 lakh claims are raised every month on an average basis and the total claims in a year may go up to nearly 27-30 lakh.