RSBY a bane for small hospitals

THIRUVANANTHAPURAM: Many small private hospitals, which have enrolled under Rashtriya Swasthya Bima Yojana (RSBY), fume over cancellation of their insurance claims by the authorities citing trivial reasons. The case sheets written by doctors are rejected by government officials claiming that they are not 'perfect.'

"How can a non-medical man verify our case sheets and find fault with them. They reject the documents and block the entire payment. When ask about the clarification on the faults, they do not give us any satisfactory explanation. Then how can we continue with such schemes which are meant to help the poor patients?" asks Dr Devin Prabhakar of Divya Prabha Eye Hospital.

Already, there is delay in the payment under this scheme. But this particular issue is now compelling most of the smaller private hospitals to withdraw from the scheme. "We cannot run after the authorities to get the money refunded since we do not have time for that," said Dr P K Mohamed Rasheed, founder president of Kerala Private Hospital Association. The verification of the case sheets are mostly done by a team that hardly has any MBBS background. It is strange how they are finding fault with the case sheets prepared by medical experts. "A case sheet on a normal delivery was rejected since instead of female by mistake it was mentioned as male. They rejected the entire amount incurred by the hospital for the delivery," said Rasheed.

It is not just the case of private hospitals alone. "Of the 100 claims submitted by us, at least 40 are rejected even in the case of government hospitals," said Dr N Sulphi, state general secretary of Indian Medical Association, who is an ENT surgeon at Chirayinkeezhu district hospital.

"They do not say which part of the case sheet was defective. In my case, only an ophthalmologist can find fault with the case sheet. So there should be an audit on the rejections made by the RSBY authorities," said Dr Devin Prabhakar, who is also the vice-president of Qualified Private Medical Practitioners Association (QPMPA).