'Never a profitable scheme': Private hospitals shut door on Mamata Banerjee's health insurance programme

KOLKATA: Patients enrolled in Swasthya Sathi, the outgoing Mamata Banerjee govt's flagship universal health insurance scheme offering Rs 5 lakh annual coverage, are being refused admission or turned away from several private hospitals across Kolkata as the facilities wait to see whether the incoming BJP govt will continue the programme or replace it with the Centre's Ayushman Bharat.

The refusals, which hospitals say are unofficial, have gathered pace since Trinamool Congress was voted out of office. At least one hospital chain on EM Bypass has stopped Swasthya Sathi admissions entirely across all its units, which together treat more than 250 such patients a month. A multispeciality hospital in south Kolkata that admitted around 30 Swasthya Sathi patients daily - mostly for cardiac procedures - has shut the door on all but critical cases.

"We are waiting for a directive from the govt, which may not come anytime soon," the head of the EM Bypass hospital chain said. A senior official at another private hospital was blunter. "We have suspended Swasthya Sathi admissions. But it's not official. It was never a profitable scheme for us, and we expect a new scheme to replace it soon," the official said.

Hospitals that have not formally barred admissions are screening patients with Swasthya Sathi cards. Woodlands Hospital is restricting the scheme to cardiac and some cancer patients, said CEO Rupak Barua, who is also president of Association of Hospitals of Eastern India. "There are issues with rates. So, most hospitals, including ours, are forced to restrict admissions to cardiac and some cancer patients," Barua told TOI.

The hospital plans to approach health department officials once the new govt assumes office to learn the scheme's fate.

Ruby General Hospital has not stopped admissions, with claims under the scheme still being approved. "We treat more than 200 Swasthya Sathi patients in a month and received admission clearances from the insurance company till yesterday. The future, however, remains unclear," said Subhashis Datta, chief general manager (operations) at Ruby. Patients with Swasthya Sathi cards have faced refusals at hospitals for years over what these facilities describe as the scheme's "poor cost structure".