The Rajasthan government will launch Bhamashah Swasthya Bima Yojna (BSBY) for 1.10 crore families in Rajasthan on December 13.
The scheme offers cashless benefit of Rs 30,000 for general diseases and up to Rs 3 lakh for serious ailments to the beneficiary. The government will pay a premium of Rs 370 per family to the insurance company.
However, NGOs working in health sector and big private hospitals have refused to come onboard claiming the government rates for medical procedures and treatments are much less than even the Central Government Health Scheme (CGHS) rates and thus not feasible.
Health minister Rajendra Rathore told reporters that the insurance scheme will not affect the existing Chief Minister Free Medicines and Diagnostic Scheme, as the proposed scheme is for indoor patients only. He said the proposed insurance scheme will benefit poor people, as they can get cashless treatment at private hospitals.
Although the health department’s joint secretary, Neeraj K Pawan claimed that 167 private hospitals have been empanelled for the scheme, but an association of private hospitals said the hospitals have refused to be part of the scheme after the government revealed rates of treatments and procedures.
Secretary of Rajasthan chapter of the Association of Healthcare Providers (AHP), Dr Sarvesh Joshi said the BSBY rates were too less and not feasible. “For example, the CGHS rate of non-medicated angioplasty is Rs 1.08 lakh and the market rate is Rs 1.33 lakh. But the government is offering only Rs 54,000 for the procedure. Since these rates are not sustainable, even the empanelled hospitals will refuse to offer cashless services to patients and the scheme will boomerang,” he said.
Rathore said Rajasthan would become the 6th Indian state to launch a health insurance scheme, but claimed that the Bhamashah scheme offered the “most comprehensive” health coverage.
He said patients can avail the cashless insurance scheme at government and accredited private hospitals. Total 1,715 disease packages have been prepared, out of which 1,045 packages are of secondary illnesses and 500 are of tertiary level illnesses.
He further clarified that in 1,045 secondary level illnesses there will be no need of pre-authentication, as government has faith on doctors and patients and in 500 tertiary level illnesses, pre-authentication will be required within 48 hours, but for the want of pre-authentication, the treatment will not be stopped and it is insurance company’s responsibility to take the pre-authentication. The scheme will be implemented through a separate society named as State Health Assurance Agency. There will be a health facilitator for 50 patients at each hospital, who will help the BSBY patients.
Pawan explained the scheme through a presentation and said it would cover 68.87% population of Rajasthan.
Jan Swasthya Abhiyan, an NGO working for healthcare issues, has also questioned the ambitious scheme. Chhaya Pachauli of the NGO said the government was making tall claims, which will remain on paper. “The insurance company will exploit the government in the name of patient and put more financial pressure on the government. There are no regulations to check private hospitals as clinical establishment act is yet to be implemented,” she said, alleging that delay in implementing clinical establishment act is to benefit private hospitals.
Pachauli said instead of the proposed insurance scheme, the government could have used the money in strengthening the healthcare facilities, which would have been more beneficial to the people.