Government health schemes bleeding us, private hospitals say

The state government's plan to include APL cardholders apart from BPL beneficiaries
in health schemes like Rajiv Arogya Bhagya has run into resistance from the private health
sector. Reason: they say the number of BPL card holders has suddenly risen from 30 per cent
to 80 per cent in government records and this data appears flawed.
Private hospital owners say they will not go ahead with subsidized treatment if the data
is not corrected. Besides, the government's decision has been unilateral and private hospitals
have not been invited for any dialogue, said medical directors of top hospitals who addressed
the media on Saturday. Doctors representing Association of Healthcare Providers India
(AHPI), Indian Medical Association (IMA), Private Hospitals and Nursing Home Association
(PHANA) and Karnataka Private Medical Establishment Association (KPMEA) have united
to address these issues before the government.
"The government itself admits that a considerable percentage of bogus BPL cards are
distributed. So how do we judge the bogus cards? The government should first streamline the
BPL card duplication and overlapping of government health scheme before starting the health
scheme for APL card holders," said Dr Ajaikumar, chairman and CEO of Healthcare Global
Enterprises.
Dr Prashanth Katakol, cooordinator, Karnataka Private Hospitals Forum, said when rich
patients are visiting hospitals in fancy cars, why should their treatment be subsidized. "The
multiple health schemes for BPL card holders cover 450 surgeries but not diseases like
typhoid or jaundice which form 95 per cent of the cases. Surgeries are just 3-5 per cent. A
needy patient with typhoid does not benefit at all. Besides, the current scheme does not
include accidental brain injury cases, which are crucial," said Dr Katakol.
"We have met the health minister and concerned authorities but with no outcome so far,
we plan to meet the CM next. There is no redressal mechanism in place for us to discuss these
issues with. The government has taken unilateral decision and has not consulted us before
announcing any scheme," said Dr K Ramadev president, Private Hospitals and Nursing
Homes Association.

Link schemes to IRDA

Currently, the state government has health schemes like Yashaswini, Nagara
Yashaswini, Vajpayee Arogya Sri, Thayi Bhagya and Bala Sanjeevini. "But none of these
come under Insurance Regulatory and Development Authority (IRDA). The Karnataka

government says its health schemes are not insurance linked. We request the government to
subject all schemes to IRDA norms," said Dr Katakol.
The doctors also demanded the urgent revision of procedural charges and services
under existing health schemes scientifically. "The prices should be reviewed annually.
Currently, private hospitals in tier two cities suffer losses because of government health
schemes. The reimbursement for surgeries by the government is much less that the actual cost
incurred," said Dr Sharan Srinivasan, co-ordinator, Karnataka Private Hospitals' forum.

More beneficiaries now

"The issues regarding Rajiv Arogya Bhagya are under discussion," said M Madan
Gopal, principal secretary, health and family welfare department. He added that the private
hospitals are seeing more BPL patients availing government health schemes because the
government has increased the geographic coverage of the scheme.
"What began in Gulbarga division has now extended to Belgaum, Bangalore and
Mysore divisions. It's not because of bogus BPL cards. If a hospital has genuine doubts about
the authenticity of a card, the matter must be brought to us with proof so that we can escalate
it to the department of food and civil supplies which issues the ration cards," he said.

Show can't go on
We are facing losses, but have not denied service to any needy patient. But the show
can't go on this way. How can we run the hospital if 80 per cent of the patients claim to be
BPL card holders?
Dr Ajaikumar | chairman, Healthcare Global Enterprises

Hospitals are benefitting

The patient load in private hospitals increased because government health schemes were
extended across the state. From 2010-11, government issued Rs 221.03 crore to private
hospitals. They benefited from the government
Madan Gopal | principal secretary, health and family welfare department

List of government schemes in India

The ministries of Government of India had came up with various schemes time to time. These
schemes could be either Central, State specific or joint collaboration between the Centre and the
States. They are detailed below:
Scheme

Ministry

Launche
d on
2007

Outlay/Statu
s

Sector

Aam Aadmi
Bima Yojana[1]

MoF

Insurance

Atal Pension
Yojana [2]

MoF

May 9,
2015

Pension

Bachat Lamp
Yojna

MoP

2009

Electrification

Central
Government
Health
Scheme

MoHFW

1954

Health

Deendayal
Disabled
Rehabilitation
Scheme

MoSJE

2003

[Social
Justice]]

Provisions
Scheme extends the
benefit of life
insurance coverage
as well as coverage
of partial and
permanent
disability to the
head of the family
or an earning
member of the
family of rural
landless households
and educational
assistance to their
children studying
from 9th to 12th
standard as an
extended benefit.
Social Sector
Scheme pertaining
to Pension Sector
reduce the cost of
compact fluorescent
lamps
comprehensive
medical care
facilities to Central
Government
employees and their
family members
Create an enabling
environment to
ensure equal
opportunities,
equity, social

Deen Dayal
Upadhyaya
Gram Jyoti
Yojana [3]

MoP

2015

Rural Power
Supply

Digital India
Programme [4]

MoC&IT

July 1,
2015

Gramin
Bhandaran
Yojna

MoA

March 31,
2007

Agriculture

Indira Awaas
Yojana

MoRD

1985

Housing,
Rural

1 Lakh Crore

Digitally
Empowered
Nation

justice and
empowerment of
persons with
disabilities.
It is a Government
of India program
aimed at providing
24x7 uninterrupted
power supply to all
homes in Rural
India
Aims to ensure that
government
services are
available to citizens
electronically and
people get benefit
of the latest
information and
communication
technology
Creation of
scientific storage
capacity with allied
facilities in rural
areas to meet the
requirements of
farmers for storing
farm produce,
processed farm
produce and
agricultural inputs.
Improve their
marketability
through promotion
of grading,
standardization and
quality control of
agricultural
produce.
Provides financial
assistance to rural
poor for
constructing their
houses themselves.

[5]

Indira Gandhi
Matritva
Sahyog Yojana

MoWCD

2010

Mother Care

Integrated
Child
Development
Services

MoWCD

October
2, 1975

Child
Development

Integrated
Rural
Development
Program

MoRD

1978

Rural
Development

Janani
Suraksha
Yojana

MoHFW

2005

Mother Care

Jawaharlal
Nehru
National
Urban
Renewal
Mission
(JnNURM)

MoUD

December
3, 2005

Urban
Development[7

Kasturba
Gandhi Balika
Vidyalaya

MoHRD

July 2004

Education

A cash incentive of
Rs. 4000 to women
(19 years and
above) for the first
two live births [6]
tackle malnutrition
and health
problems in
children below 6
years of age and
their mothers
self-employment
program to raise the
income-generation
capacity of target
groups among the
poor
One-time cash
incentive to
pregnant women
for
institutional/home
births through
skilled assistance
a programme meant
to improve the
quality of life and
infrastructure in the
cities. To be
replaced by Atal
Mission for
Rejuvenation and
Urban
Transformation.
Educational
facilities
(residential schools)
for girls belonging
to SC, ST, OBC,
minority
communities and
families below the
poverty line(bpl) in
Educationally

INSPIRE
Programme

Department of
Science and
Technology(India
)

Kishore
Vaigyanik
Protsahan
Yojana

MoST

Livestock
Insurance
Scheme
(India)

MoA

Mahatma
Gandhi
National Rural
Employment
Guarantee Act

MoRD

Members of
Parliament
Local Area

MoSPI

1999

Education

February
6, 2006[8]
[9]

December
23, 1993

Rs. 40,000
crore in
201011

Rural Wage
Employment

Backward Blocks
Scholarships for
top Science
students ,
Fellowships for
pursuing PhD ,
Research Grants
to researchers
Scholarship
program to
encourage
students to take
up research
careers in the
areas of basic
sciences,
engineering and
medicine
Insurance to
cattle and
attaining
qualitative
improvement in
livestock and
their products.
Legal guarantee
for one hundred
days of
employment in
every financial
year to adult
members of any
rural household
willing to do
public workrelated unskilled
manual work at
the statutory
minimum wage
of Rs. 120 per
day in 2009
prices.
Each MP has the
choice to suggest
to the District

Development
Scheme

Midday Meal
Scheme

MoHRD

August
15, 1995

Namami
Gange
Programme [10]

MoWR

March
1995

National
Literacy
Mission
Programme
National
Pension
Scheme
National
Scheme on
Welfare of
Fishermen

MoHRD

May 5,
1988

Education

January 1,
2004

Pension

MoA

Health,
Education

20000 crore
for 5 years

Clean &
Protect Ganga

Agriculture

Collector for,
works to the tune
of Rs.5 Crores
per annum to be
taken up in
his/her
constituency. The
Rajya Sabha
Member of
Parliament can
recommend
works in one or
more districts in
the State from
where he/she has
been elected.
Lunch (free of
cost) to schoolchildren on all
working days
Integrates the
efforts to clean
and protect the
River Ganga in a
comprehensive
manner
Make 80 million
adults in the age
group of 15 - 35
literate
Contribution
based pension
system
Financial
assistance to
fishers for
construction of
house,
community hall
for recreation
and common
working place
and installation
of tube-wells for
drinking water

National
Service
Scheme

MoYAS

National
Social
Assistance
Scheme

MoRD

August
15, 1995

Pension

MoRD

July 23,
2010

Model Village

MoF

May 9,
2015

Insurance

MoF

May 9,
2015

Insurance

MoF

August
28, 2014

Financial
Inclustion

Pooled
Finance
Development
Fund Scheme
Pradhan
Mantri Adarsh
Gram Yojana

Pradhan
Mantri
Suraksha
Bima Yojana

1969

Personality
development
through social
(or community)
service
Public assistance
to its citizens in
case of
unemployment,
old age, sickness
and disablement
and in other
cases of
undeserved want

Integrated
development of
Schedule Caste
majority villages
in four states
Accidental
Insurance with a
premium of 330
per year.

[2]

Pradhan
Mantri Jeevan
Jyoti Bima
Yojana [2]
Pradhan
Mantri Jan
Dhan Yojana

Life insurance of
Rs. 2 lakh with a
premium of Rs.
12 per year.
National Mission
for Financial
Inclusion to
ensure access to
financial
services, namely
Banking Savings
& Deposit
Accounts,
Remittance,
Credit,
Insurance,
Pension in an

Pradhan
Mantri Gram
Sadak Yojana

MoRD

December
25, 2000

Rural
Development

Rajiv Awas
Yojana [11]

MhUPA

2013

Urban
Housing

Rajiv Gandhi
Grameen
Vidyutikaran
Yojana [12]

MoP

April
2005

Rashtriya
Krishi Vikas
Yojana

MoA

August 1,
2007

Agriculture

Rashtriya
Swasthya
Bima Yojana

MoHFW

April 1,
2008

Insurance

To be
replaced by
Deen Dyal
Upadhyaya
Gram Jyoti
Yojana

Rural
Electrification

affordable
manner
Good all-weather
road connectivity
to unconnected
villages
It envisages a
Slum Free
India" with
inclusive and
equitable cities in
which every
citizen has access
to basic civic
infrastructure
and social
amenities and
decent shelter
Programme for
creation of Rural
Electricity
Infrastructure &
Household
Electrification
for providing
access to
electricity to
rural households
Achieve 4%
annual growth in
agriculture
through
development of
Agriculture and
its allied sectors
during the XI
Plan period
Health insurance
to poor (BPL),
Domestic
workers,
MGNERGA
workers,
Rikshawpullers,
Building and

RNTCP

MoHFW

1997

Health

Saksham or
Rajiv Gandhi
Scheme for
Empowerment
of Adolescent
Boys

MoWCD

2014

Skill
Development

Sabla or Rajiv
Gandhi
Scheme for
Empowerment
of Adolescent
Girls

MoWCD

2011

Skill
Development

other
construction
workers, and
many other
categories as
may be identified
by the respective
states
Tuberculosis
control initiative
Aims at all-round
development of
Adolescent Boys
and make them
self-reliant,
gender-sensitive
and aware
citizens, when
they grow up. It
cover all
adolescent boys
(both school
going and out of
school) in the
age-group of 11
to 18 years
subdivided into
two categories,
viz. 11-14 & 14
18 years. In
2014-15, an
allocation of Rs.
25 crore is made
for the scheme.
Empowering
adolescent girls
(Age) of 1118
years with focus
on out-of-school
girls by
improvement in
their nutritional
and health status
and upgrading
various skills like

Sampoorna
Grameen
Rozgar Yojana

MoRD

Septembe
r 25, 2001

Rural Self
Employment

Skill India
Programme
(National Skill
Development
Mission)

MoSDE [13]

July 15,
2015

Skill
Development

home skills, life

skills and
vocational skills.
Merged Nutrition
Programme for
Adolescent Girls
(NPAG) and
Kishori Shakti
Yojana (KSY).
Providing
additional wage
employment and
food security,
alongside
creation of
durable
community
assets in rural
areas.
seeks to provide
the institutional
capacity to train
a minimum 40
crore skilled
people by 2022
[14]

Swabhiman

MoF

February
15, 2011

Financial
Inclusion

Swarnajayanti
Gram
Swarozgar
Yojana

MoRD

April 1,
1999

Rural
Employment

To make banking
facility available
to all citizens and
to get 5 crore
accounts opened
by Mar 2012.
Replaced by
Pradhan Mantri
Jan Dhan Yojana.
Bring the
assisted poor
families above
the poverty line
by organising
them into Self
Help Groups
(SHGs) through
the process of
social

Swavalamban

MoF

Udisha

MoWCD

Voluntary
Disclosure of
Income
Scheme

National Rural
Livelihood

MoRD

Septembe
r 26, 2010

To be
replaced by
Atal Pension
Yojana

Pension

Child Care

June 18,
1997

Closed on 31
December
1998

June
2011[15]

$5.1
Billion[15]

mobilisation,
their training and
capacity building
and provision of
income
generating assets
through a mix of
bank credit and
government
subsidy.
pension scheme
to the workers in
unorganised
sector. Any
citizen who is
not part of any
statutory pension
scheme of the
Government and
contributes
between Rs.
1000 and Rs.
12000/- per
annum, could
join the scheme.
The Central
Government
shall contribute
Rs. 1000 per
annum to such
subscribers.
Training
Program for
ICDS workers
Opportunity to
the income tax/
wealth tax
defaulters to
disclose their
undisclosed
income at the
prevailing tax
rates.
This scheme will
organize rural

Mission
(NRLM)

HRIDAY Heritage City

Development
and
Augmentation
Yojana
Sukanya
Samridhi
Yojana (Girl
Child
Prosperity
Scheme)

MoUD

Jan
2015[16]

Urban
Development

MoWCD

Jan
2015[15]

Smart Cities
Mission

MoUD

June 25,
2015

[14]

Urban
Development

Atal Mission
for
Rejuvenation
and Urban
Transformatio
n (AMRUT)

MoUD

June 25,
2015

[14]

Urban
Development

Pradhan
Mantri Awas
Yojana

MoUD

June 25,
2015

[14]

Housing

poor into SHG

groups and make
them capable for
self-employment.
The idea is to
develop better
livelihood
options for the
poor.
The scheme
seeks to preserve
and rejuvenate
the rich cultural
heritage of the
country.
The scheme
primarily ensures
equitable share to
a girl child in
resources and
savings of a
family in which
she is generally
discriminated as
against a male
child.
To enable better
living and drive
economic growth
stressing on the
need for people
centric urban
planning and
development.
To enable better
living and drive
economic growth
stressing on the
need for people
centric urban
planning and
development.
To enable better
living and drive
economic growth

(PMAY)

stressing on the
need for people
centric urban
planning and
development.

See also

List of Indian government initiatives focusing on economic development

Poverty alleviation programmes in India

Future Plans News

Jawahar Rozgar Yojana 1999 To provide around 100 days of employment to rural unemployed.
The National Urban Health Mission The Union cabinet of India on May 1, 2013, approved the
launch of the National Urban Health Mission to reduce the rate of infant mortality, maternal
mortality, and for universal access to reproductive health care.

Central Government Health Scheme patients turned away by private hospitals

The officials at CGHS had earlier appointed a third party

administrator to reduce the waiting period to reimburse the
bills.

The Central Government Health Scheme (CGHS) is sitting on funds to the tune of `400 crore,
meant to be disbursed among private hospitals as part of pension scheme.
According to sources, CGHS officials have not been able to clear the pending funds, leading to
delay in treatment of patients too. The officials at CGHS had earlier appointed a third party
administrator to reduce the waiting period to reimburse the bills. In 2011, the central agency
entered into an MOU with top corporate hospitals, pooling in UTI Infrastructure Technology and
Services Limited (UTISL), to ensure bills will be cleared in 10 days after the submission.
Ads by ZINC

Officials at the department said that CGHS is yet to receive the

funds worth Rs 300 crore from UTI.

Officials at the department said that CGHS is yet to receive the funds worth Rs 300
crore from UTI. These funds are pending with UTI Infrastructure Technology and
Services Limited (UTISL), which has not been reconciled since last three years.

"It was decided that 10 per cent of every bill will be kept with UTI and rest will be paid to the
hospitals as part of reimbursement scheme. No one has bothered to clear the bills. Later in 2014,
the rates were revised and it said that 10 per cent of amount will not be deducted and 70 per cent
of the amount will be paid to the service provider," a source in the Ministry of Health and Family
Welfare told Mail Today. Now, as the previous funds have not been cleared, the CGHS in its
latest auditing found that around Rs 117 crore is also pending. These funds have been reconciled
but not released as the third party has not cleared the previous dues. "The amount has
accumulated to more than Rs 400 crore and authorities at CGHS are perplexed, as how to
distribute the funds. We have been requesting the officials to clear the same but they are not
taking the matter seriously," said a private hospital official while requesting anonymity.

The "Central Government Health Scheme" (CGHS) provides comprehensive healthcare facilities
for the central government employees and pensioners and their dependents residing in CGHS
covered cities. Due to lack of qualified doctors to properly vet the medical
bills, the reimbursement process used to get delayed inordinately.
Private hospitals have not received the payment for the last
three months. At the end, it's the patient who suffers. According to
various private hospitals, the CGHS has not released the amount
for the last three months.

"We have not received the reimbursements from the central agency. Left
with no other option, we are referring patients to other hospitals. The amount
due is in crores and we cannot allow them to continue in this way," one of
the directors of a private hospital told Mail Today.
When Mail Today contacted N.S. Kang, additional secretary and DG, he
said: "I am out of station and cannot comment on the issue right now."

Private hospitals benefit more from State insurance scheme

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RTI activist points out lapses and financial loss to exchequer

Revealing information obtained through the RTI Act on the functioning of Chief Ministers
Health Insurance Scheme, an activist has pointed out several lapses, financial loss to exchequer
due to lack of accountability and how a number of private hospitals had benefitted more from the
scheme than government institutions.
Presenting the data furnished by the Health and Family Welfare department officials, Anand Raj,
an RTI activist, and Peoples Watch Executive Director Henry Tiphagne said on Thursday that
only 83 out of 240 hospitals situated in taluks had benefitted under the scheme.
When many private hospitals made good money, it was not the case with government hospitals.
In as many as 18 government hospitals, earnings from the scheme depleted year after year, while
it crossed Rs 1400 crore for private hospitals in the last five years, they said.
Inquiries by the activist and his team with doctors in government hospitals suggested that they
had referred patients to private hospitals for a number of reasons. For instance, in taluk-level
hospitals, there were no specialists like anaesthetists. Similarly, the infrastructural facilities for
performing complicated surgeries were inadequate.
Hence, officials in the Health and Family Welfare Department had introduced incentives for
doctors and para-medical staff in government hospitals.

Though welcome, the hospitals did not have sufficient facilities, Mr. Anandraj said and recalled
the fate of a 32-year-old woman Sitalakshmi of Kanyakumari district, who slipped into coma and
died after eight months, following a complication. The revelation indicated that the taluk hospital
in Kuzhithurai did not have ventilator or other gadgets in the post-operative ward. Likewise,
another patient, Chellam of Alagapuripatti in Madurai district, who underwent surgery at Melur
taluk hospital, died on August 21, 2013, due to absence of experienced surgeons.
Keeping in mind the cash incentives, government hospitals with lesser bed strength in districts
such as Ramanathapuram and Vellore had performed more number of surgeries, while those with
higher number of beds and adequate infrastructure had not risen up to the occasion, thus raising a
question on the accountability of doctors in 30 government hospitals situated in towns such as
Hosur, Vriddhachalam, Bhavani and Gudiyatham, the data revealed.
Thanjavur last
With 1,008 beds, Ramanathapuram government hospital emerged on top in the insurance scheme
in 2014 by earning Rs. 5 crore and the Thanjavur Government Hospital, with 1,067 beds, was
ranked last as it had earned a meagre Rs 67 lakh.
Hospitals with limited infrastructure should be instructed not to experiment with poor patients
lives, the activist appealed to the government. Mr. Tiphagne mooted social audit. In the event of
death of a patient who had taken the insurance scheme, post-mortem should be mandatory as the
legal heirs could get compensation.