Hospitals in Bengal cannot charge more than Rs 5K for clinical investigation

In an advisory to the private hospitals and nursing homes, the state health department has fixed an upper ceiling of Rs 5,000 for the diagnosis and clinical investigation for the beneficiaries of Swasthya Sathi Card holders and asked them to bring the patients under packages immediately.

The decision comes immediately after Chief Minister Mamata Banerjee cautioned hospitals of strict action, including cancellation of their licences in case they deny holders of Swathya Sathi cards from its benefits.

Warning of taking strict action against the private hospitals and nursing homes, the health department advisory said, "It has occasionally been observed that the private hospitals and nursing homes go for unspecified tests in the name of clinical investigation and diagnosis. This cannot be done. The hospitals and nursing homes can spend upto Rs 5,000 for clinical investigation and diagnosis and after that the patient have to be brought under a specific package".

Despite a large number of packages being available, many healthcare providers are treating patients under the category "unspecified package" for medical management cases and for certain surgical cases which may be blocked under specified packages, it said.

According to the advisory, in case a person is not carrying the card the same must be searched with the Aadhar number of the beneficiary in the Swasthya Sathi web portal.

"In case a person does not have any of the health card, identification of the person/issuance of new card will be facilitated in the hospital itself. Similar arrangements should also have to be made for all PPP diagnostic centres," the advisory said.

The swasthya sathi scheme. launched by Banerjee on December 30, 2016, offers a basic health cover for secondary and tertiary care up to Rs 5 lakh per annum per family. Under the scheme, there are at least 1,900 packages, where a family can avail secondary and tertiary care cashless treatment up to Rs 5 lakh per annum from any of the empanelled hospitals.

According to an estimate by the state finance department the state government coughs up around Rs 8 crore daily to the tune of Rs 250 crore per month to meet the claims of Swastha Sathi. There are about 2,330 private hospitals and nursing homes under the health sector, with a total consumer of about eight and a half crores.