Govt's 'universal' health scheme does not cover OPD services

The Karnataka government’s Arogya Bhagya to be rolled out on November 1, is meant to be a universal health coverage (UHC) scheme, does it not cover out-patient services.

The scheme, which brings all programmes under a single umbrella and intends to provide treatment of up to Rs 1.5 lakh to around 1.4 crore households, does not cover diseases like dengue, typhoid, H1N1 and dysentery.

“Not all the treatments can be covered under UHC,” said Dr Rathan Kelkar, mission director, National Health Mission. He added that primary health centres treat diseases like dengue, chikungunya and typhoid free of cost and people can use the services of more than 1,000 government hospitals instead of turning to private hospitals.

Dr C N Manjunath, director, Sri Jayadeva Institute of Cardiovascular Sciences and Research said that infectious diseases like dengue, pneumonia, jaundice and typhoid constitute around 70% of cases at government hospitals. Depending on the individual, the disease may require a prolonged stay in the hospital or may increase in severity. According to the scheme, patients have to get a consent from a government hospital before approaching private hospitals. This is a limitation in the scheme, he said.

Manjunath added that though cardiac surgery for a child costs up to Rs 2.5 lakh, the cost quoted under the scheme is much less.

According to the scheme, close to 1,000 surgical procedures under secondary care can be availed free of cost in government facilities. Around 516 complicated secondary procedures that may be referred to private hospitals will also be free for Category A (priority and deprived households), while those falling under Category B will get 30% rebate. This applies to tertiary care as well.

“We have estimated a reimbursement of around Rs 5,000 per person in secondary care and Rs 60,000 for tertiary care,” said Dr Kelkar.

Health activists said healthcare is not universal as it fails to cover OPD services. “What if a person’s ailment goes beyond the prescribed amount or if the person has a rare disease? He will have to pay out of his pocket,” said Dr Sylvia Karpagam, public health doctor and researcher.

Dr Sudhashree Chandrashekhar, director of Suvarna Arogya Suraksha Trust (SAST), the implementing agency for UHC, said rare diseases are not included in the current phase as it is only a pilot project.

Dr Sudarshan Ballal, chairman, Manipal Hospital said that if everyone is insured under the scheme, then there will be a huge number of patients seeking treatment. This needs more infrastructure, allocation of funds and a payment mechanism. “How will it be implemented?” he asked. Dr Sudhashree said private hospitals have to claim reimbursements online.