Govt hospitals get a raw deal in reimbursement by Medisep insurer

Before the Medisep scheme came into force, it was decided to apply the same rate for all hospitals. Photo: Shutterstock/ Valeri Potapova

Thiruvananthapuram: The Medical Insurance for State Employees and Pensioners, better known by its acronym MEDISEP, has proven to be a losing proposition to empanelled government hospitals in Kerala. Oriental Insurance Company Limited, which reimburses hospitals participating in the scheme, pays much lower amount to government hospitals when compared to private ones even for the same procedures.

Medisep lists 1,920 treatment procedures and services for reimbursement. In the majority of these procedures, private hospitals receive more than double the amount the government hospitals get from the insurer.

For a normal delivery of a single child or twins, a government hospital receives Rs 7,000 from the insurance company. However, private hospitals are reimbursed between Rs 15,000 and 17,000 depending on the slab for a single birth and Rs 16,400-19,000 for twins.

Similarly, Rs 12,000 is paid for a Cesarean (C-section) for single as well as twin birth at government hospitals. Meanwhile, the insurance company reimburses Rs 15,600-18,000 for single-child Cesareans and Rs 16,400-19,000 for twins.

Cataract operations at government hospitals are reimbursed only Rs 4,000, while private hospitals receive Rs 22,500-25,900 for the same procedure. The reimbursement amount for bypass surgery at a government hospital is 1.18 lakh and for private institutions is Rs 1.70 lakh.

Blame it on differential slabs

While three slabs have been fixed for private hospitals depending on their number of beds, the same rate applies for all government hospitals, from the primary health centres to medical college hospitals. This causes huge losses to government hospitals.

Before the Medisep scheme came into force, it was decided to apply the same rate for all hospitals. Subsequently, the insurance company implementing the scheme entered into agreements with Directorate of Health Services (DHS), under which all government hospitals up to District and General Hospitals function and the Directorate of Medical Education (DME) which manages the Medical College Hospitals. The current rates are based on these agreements.

However, officials at the Department of Health said that they were not aware of these agreements. At the same time, it is learnt that there was pressure from the government to finalise the agreements before the scheme was implemented.

During the discussions conducted by the government over the scheme, Finance Minister K N Balagopal said that only an agreement signed by the Finance Ministry with the insurance firm would have validity. Even then, the government is paying the rates mentioned in the agreements signed by DHS and DME to government hospitals.

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