'State clearing Swasthya Sathi related dues within 30-day billing cycle'
Kolkata: Despite the financial crunch, the state government has been clearing Swasthya Sathi related dues to all private hospitals within the 30-day billing cycle and in case of failure, the hospitals have been paid interest at the rate of 1.5 percent beyond the stipulated time, said a senior health official.
The payment process gets delayed only in those cases where the Health department is not convinced with the billing done by the hospitals. The government pays over Rs 200 crore every month to private hospitals for the smooth running of the Swasthya Sathi scheme, a brainchild of Chief Minister Mamata Banerjee. The state has allotted over Rs 2,300 crore when the Swasthya Sathi scheme was expanded to cover the entire population in December last year. Therefore, there is no question of Swasthya Sathi dues, added the official.
"After the bills are raised by private hospitals on the Health department portal, the department examines them and the process is delayed when further investigation takes place. The payment is done within 30 days from the day on which the claim was registered. In case of unjustified bills, the payments are delayed. The status of every claim is uploaded on the government portal. Even the accumulated interest is shown in case of delayed payment by the government. Initially, the billing cycle was 15 days but following a huge rise in the number of beneficiaries, the billing cycle has been extended up to 30 days," a top Health department added.
Around nine crore people in Bengal have already been included under the Swasthya Sathi scheme out of which around 6-7 percent raise claims every year. As per mass insurance statistics, at most, around 6-7 percent of claims are made out of the total number of people enrolled under that particular health scheme. In case of the Swasthya Sathi scheme, 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, highly placed sources in the Health department said.
"The state government sanctioned over Rs 2,300 crore when the scheme was expanded to the entire population and the expenditure of the Swasthya Sathi remains under the allocated budget. If the total costs go up to Rs 2,600 crore, it can be assumed that some incidents of pilferage are happening. It is difficult to check when the pilferage is less than 10 percent. It is also difficult to identify such cases when private hospitals run a nexus with patients and submit fudged bills," the official added.
More than 2.30 crore families have been covered 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. There is no cap on the family size and all pre-existing diseases are covered. Unlike the Centre's Ayushman Bharat, the Swasthya Sathi is totally funded by the state government.
