Karnataka govt owes its hospitals Rs 316 crore for 2 lakh+ procedures in 3 years – ET HealthWorld

Taking note of huge arrears during a recent audit, the health and family welfare department has written to the Suvarna Arogya Suraksha Trust (SAST) for immediate clearing of the same.

“The pending claims awaiting payment are more for government hospitals than private hospitals. Private hospitals aggressively follow up on their payments, whereas public health institutions wait for the same,” a senior bureau- crat in the know of the developments said.

The issue came up for discussion on Wednesday during a review meeting with the health minister. As per the data shared with TOI by health minister K Sudhakar, the pending claims with SAST to be paid to private hospitals from 2019 till March 22 this year is Rs 230 crore.

“This amount is most needed for public health institutions for their development. How do we motivate doctors in government hospitals if payment is delayed for three years?” said district level officers, who face tough questions from colleagues across districts over pending payments.

The co-branded health scheme AB-ArK assures free healthcare services up to Rs 5 lakh per year to patients from BPL families not covered by any other health insurance scheme. APL families will be eligible for assistance of 30% of the package rates up to Rs 1. 5 lakh per family per year and the rest has to be borne by the patient.

24 dist hosps awaiting payments of Rs 60cr

Since the time the co-branded health scheme began in Karnataka in 2018, district-level hospitals have been seeing a facelift in terms of treating patients requiring surgeries. As per the rider that comes with the scheme, cases can be referred to private empanelled hospitals only when the government hospital concerned is unable to provide the required treatment through surgery.

The 24 district hospitals in the state have conducted a total of 92,181 procedures from April 2019 to March 2022 and are awaiting payments of Rs 60.2 crore. The pending claims also include select procedures done by 750 primary health centres. “The claim amount include incentives for the doctors and all operating staff. Unless they are paid incentives periodically, how do we boost their morale further? The amount is also used for development of hospitals. The smooth functioning of government hospitals, in turn, has its impact on public health at large,” officers said.

When contacted, D Randeep, health commissioner, said the matter has been taken up with SAST. While SAST executive director NT Abroo was unavailable for comment, the details of payments made to the government and private hosptials under AB-ArK over the past three years could not be ascertained.

Private Hospitals and Nursing Homes’ Association (PHANA) president Dr HM Prasanna said pending claims have been an issue with private hospitals too. “We definitely pursue our payments. But we don’t know if private hospitals get priority for payment or public health institutions. I think it’s done simultane- ously depending on claims. As on March 2022, private hospitals are waiting for Rs 170 crore for Covid treatment related reimbursement pending before SAST,” he said.

When contacted, TK Anil Kumar, principal secretary, health and family welfare department, said payments to government hospitals was on the lesser side. “Salaries and operating expenses in government hospitals are fully paid by the government unlike in private hospitals. SAST is essentially trying to procure medical facilities in private hospitals, which are non-existent in government hospitals,” he said.

Kumar said that most of the claims were cleared in November 2021 and pending claims will be cleared within a week.
“But a norm has to be devised on payment issues with regard to government and private hospitals and I have told SAST authorities about the same. There has to be a delicate balance,” he said.