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Curbing Inflation Of Private Hospitals’ DDSSY Bills

THE state government has now made it mandatory for the private hospitals empanelled under the Deen Dayal Swasthya Seva Yojana (DDSSY), its flagship health insurance scheme, to take a written feedback from the patients on discharge. This has been done to rein in inflation in billing. DDSSY is a comprehensive scheme which includes cost of hospitalization and procedures including materials and medicines. Henceforth a declaration and consent of the patient would be mandatory for processing the DDSSY claims of private hospitals. There have been scores of complaints from patients that private hospitals have been inflating the bills and making patients pay additional amount for treatment under one pretext or the other. The state government had rolled out DDSSY in 2016 for free availing by Goans of as many as 447 procedures. The diseases included were those on which out-of-pocket expenditures are high. The complaints regarding inflated charges started flowing soon after the scheme was rolled out, but the action against the errant hospitals could not be taken for one reason or the other. The government had recently suspended a reputed hospital from the scheme for charging additional money from patients under the scheme.

Private hospitals have been great beneficiaries of DDSSY. There was rampant misuse of Mediclaim, the earlier medical insurance scheme of the Goa government. The state government paid hundreds of crores of rupees to hospitals in other states empanelled under the Mediclaim scheme for treating Goan patients in specialities that were not available in the state. The Mediclaim scheme has since been discontinued. Similar manipulations were envisaged at the time of implementation of the DDSSY and the beneficiaries were warned against paying additional fees at private hospitals to avail the benefits of the government’s health insurance scheme. The government had made it clear that those who wanted additional facilities, like private rooms, could avail them at their cost. It would be beyond control to monitor the process of treatment for every patient in private hospitals. Private hospital managements can be greedy and inventive in maximizing their earnings from DDSSY.  However, it is public money, and the government is the custodian of that public money, so it has a duty to set up mechanisms to prevent private hospitals from profiteering. The latest directive for a patient feedback is only a small step the government has taken. It needs to take many more steps to prevent inflation of private hospitals’ DDSSY bills.

There have been complaints of ‘unnecessary’ tests and procedures being conducted on patients at private hospitals. Though the government laid down norms to be followed by the hospitals not all were being followed. There being no scope for direct government oversight on the process of treatment at the private hospitals, the government could lay down stricter processes. More than a year has passed since the scheme was implemented. The government ought to study the data and take strict measures to prevent drainage of the funds under the DDSSY scheme. Now that the government is in the process of revising the scheme in order to bring in more procedures and more hospitals under its ambit as an exercise of streamlining the flagship medical insurance scheme it has to ensure that the loopholes that existed were plugged. There should be proper co-ordination between the directorate of health services, the insurance company and the private hospitals for honest, proper and smooth implementation of the scheme.

The government should learn from the systems devised by some of the developed nations with respect to healthcare insurance. Each DDSSY cardholder should be screened for illnesses every six months or annually. The screening should include dental care. The data of every patient must be fed in computers and stored at a central server so that the patient’s history of illnesses, blood groups, etc was easily accessible to treating doctors.  The data will help cut down repeated tests and the cost involved in the process. This will help doctors to find out ailments among the Goan population and treat diseases before they become unmanageable. Treating diseases at the root point will help in preventing their spread and also cut costs. As medicine is a noble profession doctors in private hospitals should uphold their nobility by strictly adhering to the principles attached to their profession and refrain from allowing any misuse of the scheme to further their or their hospital managements’ interests. The government on its part should evolve a system to make sure that all the empanelled private hospitals are kept under strict watch to make them provide healthcare at legitimate prices under the scheme.

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