Govt Insurance Schemes a Bonanza for Cardiac Hospitals?

Govt Insurance Schemes a Bonanza for Cardiac Hospitals?

Published: 22nd February 2014 08:11 AM

 

Government health insurance schemes for the poor are shelling out large amounts for cardiac treatments in the state, raising the suspicion that hospitals could be making undue profits on insurance claims. Some doctors, however, stoutly deny this.Statistics from the Department of Health and Family Welfare, whose Suvarna Arogya Suraksha Trust manages these schemes, show that nearly 30 per cent of all patients treated under the Vajpayee Arogyashri are heart patients. Between April 2013 and January this year, 28.7 per cent of the funds under the Yeshasvini Cooperative Farmers Healthcare Scheme also went for cardiac treatment, for just 10 per cent of the total number of patients.

The medical fraternity and the government are divided on the reasons for this. While some say expensive cardiac procedures give hospitals easy money, others feel that heart diseases are sending more poor people into hospitals.

According to the Health Department, between April and December 2013, Narayana Hrudayalaya and Sri Jayadeva Institute of Cardiovascular Sciences and Research, hubs for cardiac care in the state, together received 25 per cent of the total amount under the Vajpayee Arogyashri, a central government scheme. Kidwai Memorial Institute of Oncology, where 3,161 (28 per cent) of the patients went, received only 11.5 per cent of the share.

Nearly Rs 13.74 crore was disbursed to Narayana Hrudayalaya.

This is 14 per cent of the total of Rs 97.36 crore given to the top 10 hospitals across the state. Nearly Rs 10.77 crore was given to Jayadeva Hospital. Of the 447 tertiary care procedures listed under the Vajpayee Arogyashri, 138 are for cardiovascular diseases. The cost of these procedures ranges from as low as Rs 3,000 to Rs 1.5 lakh.

Many doctors believe that the schemes benefit hospitals treating patients for heart problems. Dr K Srinath Reddy, president, World Heart Federation and Public Health Foundation of India, said surgeries are being done even for mild conditions so that the hospitals can gain. Dr Reddy, who is also a former head of the cardiology department at the All India Institute of Medical Sciences (AIIMS), told Express that while these schemes help people, a money-making exercise is possible.

Dr C N Manjunath, director of Jayadeva Hospital, disagrees. He said the incidence of cardiac diseases is on the rise even in rural areas. “Prevalence of heart disease is increasingly common in low and middle-income families,” he said.

Dr Devi Shetty, chairman of Narayana Health, said there is more awareness among people on cardiac treatment. This is sending more people to hospitals, Dr Shetty said, and denied monetary advantage to hospitals. “The payment we receive for procedures under this scheme is very low and not really an incentive for hospitals, which explains why very few hospitals are actually part of the network,” he said.

A study by D Rajashekar, professor and head, Centre for Decentralisation and Development at the Institute for Social and Economic Change (ISEC), found that in 2012, 2,637 of the 5,602 cases (47 per cent) treated under the Vajpayee Arogyashri in Belgaum were cardiovascular and 68 per cent of the amount claimed fell under this category.

A similar trend was found in Gulbarga where heart diseases accounted for almost 60 per cent of the cases treated and 76.85 per cent of the money claimed. The study found that from the inception of the scheme till December 2013, heart diseases accounted for 44 per cent of the total approved preauthorisations and cancer 35 per cent, together claiming 79 per cent of all approved cases.

Non-cardiac Cases

Doctors feel that the distribution of funds is unfairly advantageous to the costlier cardiac procedures, leaving other hospitals with very little or no funds to treat other diseases. As a result, several patients are getting turned away, although they hold BPL cards and are eligible for treatment.

In fact, so many beneficiaries turn up at these large super-specialty hospitals that they are made to wait for months to get a surgery done, said a top official of the Suvarna Arogya Suraksha Trust. “Poor patients are then forced to pay regular rates so that they can get timely operations done,” said the official. This holds true for all categories of surgeries under the Vajpayee Arogyashri, he said.

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