Hyderabad: The State Employees’ Health Insurance Scheme has reached a roadblock with 15 major corporate hospitals refusing to sign the Memorandum of Understanding with the state government as they claim that it was a loss-making venture and would deteriorate their health infrastructure.
Dr Bhaskar Rao, president of the All Super Speciality Hospitals’ Association, has categorically told the government that no packages can be offered to insurance patients as they are “paid patients” and can opt for the best.
“For Aarogyasri, a package was designed keeping the cost in mind. But a ‘paid patient’ can ask why a drug-eluting stent is being used and not a biodegradable stent? Given a variety of choice, patients may demand things that can’t be ascertained in a package. And the government is not ready to understand that. Our cost compulsions don’t allow us to opt for the scheme,” Dr Rao said.
The moot problem is the cost of diagnosis, which in case of employees, will have to be done for free, and claims can be made only for those who are admitted as in-patients.
In hospitals, out of 100 patients, only five may require admission but the cost of diagnosing for the remaining 95 can be tremendous.
These anomalies are not acceptable to the hospitals and they have categorically asked the government to “spare” them. While the pressure from the government is mounting, general secretary of ASHA, Govind Hari said, “We are very clear that we will not accept the scheme in the present state. It requires a lot of fine tuning and till that is done, it is not acceptable.”
While the backdoor tactics of exerting pressure from the vigilance department is increasing, the ASHA members are not ready to budge.
A senior state government official with Aarogyasri said, “We can’t leave these hospitals out as they are the best. Employees are keen that these hospitals must accept as they often frequent these hospitals for treatment. Of 252 empanelled hospitals, 125 small hospitals and nursing homes have signed. For the success of the scheme, the corporate hospitals’ agreement is required.”...