Trouble for state health insurance schemes in Andhra Pradesh, Chhattisgarh

Private hospitals threaten to discontinue treating patients

By Kundan Pandey
Last Updated: Saturday 04 July 2015

The ambitious plans of Chhattisgarh and Andhra Pradesh governments to treat patients through insurance schemes are facing a major hurdle. While private doctors of Andhra Pradesh have declared they will not treat below poverty line patients covered by state health insurance from next month, those in Chhattisgarh have expressed their unwillingness to treat patients under a similar scheme targeting people above poverty line.

The conflict surfaced in Andhra Pradesh’s scheme named Rajiv Arogyasri and Chhattisgarh’s Mukhyamantri Bima Suraksha Yojana (MBSY). The former scheme targets people below poverty line (BPL) in Andhra Pradesh while the Chhattisgarh scheme is meant to include people above poverty line (APL) in the existing health insurance scheme. The Central scheme, Rashtriya Bima Suraksha Yojana (RSBY), already covers BPL families.

Under these schemes, private hospitals are roped in to provide better healthcare facilities to people. However, private doctors of both the states are not willing to treat the patients in the amount given under the insurance schemes.

Private hospitals in Andhra Pradesh have threatened to discontinue treatment of patients from May 3 if their demands are not fulfilled.
Speaking to Down To Earth, president of AP Specialty Hospitals Association, B Bhaskar Rao, said that the government launched Rajiv Arogyashri six years ago. Since then, there has been no hike in the amount; the private doctors’ association has been requesting the government for the last two years to increase the amount but to no avail, he said.

“We have told the government that if it does not hike the amount by 30 per cent, we will have to take some tough decision. We will not continue admitting to patients coming under the scheme from May 3 onwards,” Rao said.
Their other demand is yearly increase of five per cent per in the amounts paid by the government for different treatment. Rao added that 200,000 patients go through surgery every year under this scheme for 938 listed diseases.

Similarly, Chhattisgarh government is also facing tough time in launching the ambitious programme to provide healthcare facilities to patients of APL category. The private hospitals have refused to provide treatment with the given amount. They are demanding to increase in the insured amount from Rs 30,000 to Rs 1.5 lakh.

President of Chhattisgarh chapter of the Indian Medical Association (IMA), Ajay Sahay, said that inflation is increasing and everything is costly. “How can government even think of providing treatment to patients of all categories in this amount?”

When asked how the patients of BPL category were being treated so far, he said that the hospitals were earning from general people and spending on poor patients. With the new scheme of the Chhattisgarh government, everybody will get treatment in this amount only.

“If the government does not consider our demand, we would not treat patients,” he said.

Both Rao and Sahay expressed hope that the problems will be sorted through negotiations with government officials.

Andhra Pradesh’s Rajiv Arogyasri scheme

The Andhra Pradesh government launched the Rajiv Aarogyasri Healthcare Insurance Scheme in 2007 for the 20.3 million BPL families in the state. Under it, BPL families can avail health benefits through affordable insurance. The premium for this policy is financed by the government. A sum of Rs 1.5 lakh is reserved for each BPL family with a buffer amount of Rs 50,000 for unexpected expenditure.

Chhattisgarh’s MBSY scheme

The Chhattisgarh government’s Mukhyamantri Bima Suraksha Yojana (MBSY) offers similar facilities like RSBY, a Central government scheme to provide healthcare to BPL families. The state has offered to pay the insurance premium from October 1 for all those not covered under RSBY. In the pattern of RSBY, this scheme also provides annual health insurance cover of 30,000 to each APL family.

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