A recent advise was sent by the state health department of Bengal to hospitals and district authorities concerning the Swasthya Sathi health insurance policy, which is a premier initiative of the Mamata Banerjee government. According to this recommendation, if a patient is admitted to a hospital under the program for longer than ten days, a medical audit must be performed. The directive seeks to prevent any abuse and guarantee the efficient and honest execution of the program.
The June 24 recommendation states that the Medical Audit team must be consulted in common medical management issues when an in-patient department (IPD) patient’s stay surpasses 10 days. Examining the necessity and validity of extended hospital stays under the program is the goal of this step. The document does not state precisely what fines or sanctions will be taken against the treating physician, the implementation support agency (ISA), or the concerned hospital in the event of non-compliance, but it does warn that they will be taken.
The director of health services, Siddhartha Niyogi, stressed how serious the agency is about following these regulations. He restated that in order to maintain transparency and avoid abuse, all authorities associated with the Swasthya Sathi Scheme are required to adhere to the guidelines when admitting patients.
The introduction of this audit measure by the health department was brought about by reports of inconsistencies in the scheme’s execution. A senior health official stated that certain patients admitted for a particular surgery later had extra procedures performed that were not part of the admission package. Because this technique resulted in more invoices for the government, it sparked suspicions of malpractice. Extended hospital stays—beyond what is medically necessary—raise costs and put more money on the state’s plate for the program.Chief Minister Mamata Banerjee introduced the Swasthya Sathi Scheme on December 16, 2016, offering a basic health cover of up to ₹5 lakh annually to each enrolled family. The recipients are not expected to make any financial contributions to the program, which is fully sponsored by the state. Currently, this scheme covers over 2.4 crore families, and more than 2,400 hospitals have signed up to take Swasthya Sathi cards.
The program has encountered a number of difficulties and accusations of misuse despite its extensive reach and substantial advantages. One persistent problem is that certain hospitals and private nursing homes, particularly those in rural areas, have been charged with charging patients’ families extra money than what the Swasthya Sathi package covers. The intention of the program, which is to provide free and accessible healthcare, has reportedly been undermined by these institutions’ refusal to admit families if they do not agree to pay additional fees.In her administrative meetings, Chief Minister Mamata Banerjee has brought up these concerns several times, emphasizing the necessity for strict procedures to guard against exploitation and make sure the program accomplishes its goals.
The new recommendation shows how committed the administration is to taking on these problems head-on. In an effort to improve accountability and stop financial mismanagement, the health department has instituted required audits for prolonged hospital stays and threatened fines for noncompliance. This step is anticipated to protect the integrity of the program and guarantee that recipients obtain the required medical care without being exploited or burdened excessively financially.
In order to guarantee the program’s correct execution, the state health department’s recommendation for medical audits under the Swasthya Sathi plan is a major step forward. The government works to safeguard the interests of beneficiaries and maintain the scheme’s goal of offering comprehensive and free healthcare to the people of Bengal by addressing possible malpractices and putting an emphasis on responsibility.
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MEDICAL DIALOGUES
