A majority of hospitals empanelled under the flagship Rashtriya Swasthya Bima Yojana (RSBY), a cashless health insurance cover to below poverty line (BPL) families in the unorganised sector, are not prepared to treat patients under the scheme in the state.
A recent survey of implementation of the RSBY in hospitals, both government and private, in the state conducted by the Bangalore-based Institute for Social and Economic Change (ISEC) revealed that eight of the 10 participating hospitals reported having treated fewer than 10 patients under the scheme, and one out of four hospitals have not treated a single patient since the launch of the scheme.
The main reason, according to the surveyed hospitals, are inadequate training in the use of card-reading equipment, delays and reductions in the payment due from the insurance company to the hospitals, and imposition of non-contracted upper limits on treatment duration and cost.
D Rajasekhar, Head, Centre for Decentralisation and Development, ISEC, who led the survey team, said, “Inadequate attention has been paid to proper installation and training hospital staff in the use of the necessary technology. There is an urgent need to improve communication between hospitals and the parties. The annual renewal of membership is coming up, but I fear unless some immediate corrective action is taken and hospitals start treating patients, many present beneficiaries will find that renewing the card is not worth the Rs 30 cost.”
The government launched the RSBY in five districts in March 2010, and intends to extend the scheme to all districts during the next financial year.
Presently, the scheme covered five districts — Bangalore Rural, Belgaum, Dakshina Kannada, Mysore and Shimoga. The scheme envisages cashless health insurance cover up to Rs 30,000 a year on hospitalisation to a BPL family (a unit of five) in the unorganised sector.
Being implemented by the State Department of Labour, the annual fee payable by the household is Rs 30, the remainder of the premium being paid by the state and central governments. The facility provides access to a network of participating private and public hospitals.
The RSBY implementation has been marred by delays in enrollment, training and reimbursement of hospitals. Nearly, 80 per cent of the hospitals interviewed were enrolled at least two months after the roll-out of the scheme. This means that households were given very limited information about participating hospitals when they were enrolled into the scheme about nine months ago.
The survey revealed that 36 per cent of hospitals reported severe problems in using the smart-card equipment. In many cases, hospital staff has still not received the training required in operating the equipment and software. Other hospitals reported that the software was not functioning properly.
The scheme operates on the basis that hospitals should get their expenses reimbursed from the insurance company which is operating the scheme. Treatment covered by RSBY should be entirely ‘cashless’ from the point of view of the cardholders. However, interviewed hospitals reported a delay of up to six months in payment of the submitted bills by the insurance company. One hospital reported having already withdrawn from the scheme due to these delays.
The staff from one hospital noted that, in violation of their agreement “we are being instructed that the patients should not be admitted for more than one day. They are also indicating the maximum cost that can be booked.”
One interviewed doctor noted that the major problem is a lack of proper communication. Apart from not being trained in the use of the equipment, hospitals do not know who to turn if payments are not received on time.
Another doctor pointed out that the RSBY patients come to his hospital with high expectations. On arrival they are told the software is not working, and they go back disappointed. In some cases, the data stored in the smart cards do not match the patient information. In some cases the beneficiary names or fingerprints are incorrect, forcing the hospitals to charge patients for their treatment. In other cases, the stored photographs are of such low quality that it is difficult to establish the identity of the person.
Under the scheme, each beneficiary household is provided with a smart card with details such as names, photographs and biometric data. The beneficiary household can visit any participating hospital in the country, present the card and obtain free treatment. The smart card is used for identification, but also to process client transactions at the hospital so that no cash outlay from the patient is necessary.
