Aarogyasri, the health insurance scheme for the poor, has turned into a gold mine for corporate hospitals in the state. The hospitals prefer to take child heart surgery cases under Aarogyasri instead of the Child Heart Surgery Scheme as they stand to make twice as much. They have almost stopped surgeries under the Child Heart Surgery Scheme.
Private hospitals make around Rs 1 lakh for each cardiovascular surgery on a child under the Rajiv Aarogyasri Community Health Insurance Scheme. They get paid just around half of that — between Rs 40,000 and Rs 60,000 — for a similar surgery under the Child Heart Surgery Scheme. “Hospitals get at least Rs 25,000 more for child heart surgeries under the Aarogyasri scheme,” said Dr B.T. Prasad, a child heart surgeon at Gandhi Hospital. “At Gandhi Hospital, we take up child heart surgery under Aarogyasri, even though government hospitals still conduct operations under the Child Heart Surgery Scheme.”
An official of health department said corporate hospitals initially undertook cases under the Child Heart Surgery Scheme as they were doing poor business. “After Aarogyasri, their beds are full and they find no need to take heart surgery under the regular scheme,” he added. Corporate hospitals have even set up separate wards for Aarogyasri.
They are also making a killing by selling standard 300 ml blood bags for Rs 1,200, while government hospitals and most blood banks charge only Rs 300 to Rs 500.
“In some cases, private hospitals are asking patients to buy blood from outside,” an official said. “Under Aarogyasri, the patient should not have to spend anything on the surgery.” The situation is even more appalling when one considers that 95 per cent of funds under Aarogyasri have gone to private hospitals and only 5 per cent to government hospitals, the official added. The principal secretary (health), Mr P.K. Agarwal, has a different take. “We can’t compare the schemes,” he said. “Under Aarogyasri, the hospitals are refunded all expenses, from transport to food charges. Aarogyasri is applicable to those below the poverty line and the Child Heart Surgery Scheme is open to everybody.”
Meanwhile, the government plans to extend Aarogyasri to include trauma cases and lung, paediatric and intestinal surgery. The Aarogyasri scheme, which covered 73.5 lakh BPL families in eight districts in its first two phases, will be extended to more districts soon.