Huge dues from private hospitals are piling up on the state government and these hospitals are turning away patients under the Swasthya Sathi scheme.


New Delhi: West Bengal Chief Minister Mamata Banerjee’s pet project, the Swasthya Sathi scheme, that aims to provide free of cost universal healthcare to all citizens of Bengal, is virtually on the ventilator as dues from private hospitals amounting to crores of rupees piling up on the state government and, in turn, these hospitals are turning away patients under the scheme, making them either run from one hospital to the other or forcing them to pay over the prescribed government rates.

The hospitals’ association of Bengal has also alerted the state government that they would not be able to admit patients any more under the Swasthya Sathi scheme as the government has failed to clear dues for months. They have also apprised the government about the low prescribed rate for treatment and procedures being given to these hospitals by the government for treatment under the scheme and made it clear that it would make them unsustainable in the coming years.

The Association of Hospitals of Eastern India (AHEI), one of the strongest hospital bodies that is represented by super specialty hospitals of Kolkata, has also written a letter to West Bengal’s Principal secretary, Health and Family Welfare, Narayan Swaroop Nigam, a copy of which is with The Sunday Guardian, stating similar concerns of long pending over dues to the hospitals and “abysmally” low rate for procedures and treatments set by the government.
The AHEI, that represents hospitals like AMRI, Woodlands, Apollo Gleanagles, Narayan Healthcare, Fortis, Charnock, Ruby General hospital, Medica Super Speciality hospital, Bellevue Nursing home, among others, have in their letter to Nigam said, “During our earlier discussion…it was mutually agreed that payments would be made within 20 days of submission of necessary documents. But, unfortunately, there has been delay in reimbursing bills of patients treated under Swasthya Sathi… and the accumulated amount has become sizeable, making it difficult for us to admit more patients under the scheme…”

According to some hospitals, the total due that is pending with the state government under the Swasthya Sathi scheme ranges from Rs 150 crore to Rs 200 crore. The AHEI, through the letter, also requested to revise the existing cost of treatment being provided by the government to these hospitals, stating that the cost of treatment has increased over the years, but the rates of the government has remained almost the same for the last three years.
For example, in the cardiology section, the West Bengal government has fixed the rate of Cardiac Catheterisation at Rs 8,000, while the actual rate charged by hospitals in Bengal and elsewhere in India is somewhere between Rs 16,500 to Rs 20,000. A Single Chamber ICD implantation which is a procedure done related to the heart is priced at Rs 30,000, but doctors say that the actual pricing for this procedure costs about Rs one lakh. Similarly, other surgeries like the Whipples surgery, which is a pancreatic surgery and costs about Rs 4 lakh in Kolkata, has been priced at Rs 2 lakh under the West Bengal government’s Swasthya Sathi scheme.

At this rate, many hospitals say that they would have to shut shop in Bengal in the next few years, since it has become “impossible” for private hospitals to provide treatment at this cost. A small 90-bedded hospital in Bengal that did not wish to come on record told this correspondent that for a small hospital like theirs to provide treatment to patients at such low costs is not sustainable and, moreover, they said that the Bengal government is unable to pay dues for the treatment that is already given to hundreds of patients, creating backlog of payments for this particular hospital running into some crores of rupees.

Dr Kunal Sarkar, Senior cardiologist and Senior Vice Chairman and Director Medica Hospitals, told The Sunday Guardian that the West Bengal government is run by a bunch of retired advisors who are advising the Chief Minister with unmethodical thinking. “The Swasthya Sathi scheme at the face of it is a brilliant idea, but when we come to the practicality of it, it is skewed in many ways. Serving the entire population of the state by private hospitals by this rate (government prescribed rates of treatment), they will all go bankrupt in some years. The super-specialty hospitals need to keep their machines and manpower up-to-date, they need to upgrade their technologies from time to time, give the best of services to patients and you can’t expect to do all this by pitching in from your own pocket,” Dr Sarkar said.

Dr Sarkar also added that most of the private hospitals are now not even taking patients for complex surgeries or treatments under the Swasthya Sathi scheme as the rates are too low. Neuro Surgery, cancer treatment, etc are not being done for these patients by most hospitals.

Even a nursing home from Bengal’s North 24 Parganas said that they are not taking Swasthya Sathi patients since they are unable to get funds from the government and the massive delay is causing problems with their payment schedule. One of the senior management of this nursing home told this correspondent, “The government can wait to give us our payment, but our staff has families to feed; we can’t keep them waiting for months for their salary. If it is an emergency case, we will treat them, or else, we cannot afford to go bankrupt for this government.”

Even the West Bengal Doctors’ Forum has written a letter to the health department of Bengal, seeking to address this issue at the earliest, a copy of which is available with The Sunday Guardian. The department in their letter said that due to the non-payment of dues by the government under the Swasthya Sathi scheme to the hospitals, the hospitals have started to deny payment to the doctors as well. Dr Kaushik Chaki, Secretary of the Bengal Doctors Forum, told The Sunday Guardian, “For private practitioners like us, this is our source of livelihood and if hospitals do not pay us, how are we to sustain ourselves. Unlike government doctors, we do not get a fixed monthly salary, we get from our visits and consultations and surgeries and for the services we have given it is our due that we are asking. The hospitals are saying that they are unable to pay since the funds are stuck with the government; we have kids and their school fees, EMIs etc. In this case, we are left in the lurch as well. Therefore, we have written to the government to clear the dues as soon as possible.”

Even patients are having to bear the brunt of this scheme which was launched with much fanfare last year. Card holders requiring treatments are being told to go from one hospital to the other, sometimes due to the “non-availability of beds” and sometimes due to the “non-availability of doctors”. The Sunday Guardian spoke to a handful of patients who were turned away by hospitals; they all say that the hospitals either make excuses that there is no bed or say that the treatment is not available with them. The Swasthya Sathi scheme was in service since 2016, but then it was only limited to healthcare workers like ASHA workers and other marginally poorer sections of people who were not under the government’s health care system. But soon before the West Bengal Assembly elections, last year in January, Chief Minister Mamata Banerjee in a much advertised programme, extended the Swashthya Sathi scheme to all the people of Bengal with the aim to provide free health care to 10 crore people of the state.

The scheme was received with much enthusiasm among the people of Bengal who queued up for hours and hours to get themselves registered for this scheme through the months of January, February and March last year. Under this scheme, every household having a female member would be getting a Swasthya Sathi card that would act as health insurance of Rs five lakh for each member of a family up to five members. The Bengal government then had estimated that somewhere between Rs 2500 crore would be spent to implement this scheme throughout the state, every year. But then the large number of people enrolled in this scheme has raised the expenditure under the scheme, putting extra burden on the exchequer.

The West Bengal government already has a fiscal deficit of 3.64% (Rs 62,397 crore) of the state’s GDP and a revenue deficit of 2.55% (Rs 28,280 crore) of the state’s GDP, leading to extra borrowing to meet the expenses of the state.
Dr Kunal Sarkar said that the state government, in order to fund this project, needs to increase the state’s healthcare budget to at least 6% of the state’s GDP. “This scheme is slowly falling flat on the government’s face. To cater to such a huge population of 10 crore people with free health care with the current financial status of West Bengal, it is impossible. What the government should have done is implemented it like the Ayushman Bharat scheme of the central government where the needy people would get benefits of the scheme, but then our Chief Minister wants to play messiah for all, that cannot happen in reality. This scheme is now literally in the ICU.”