Health scheme fails to take off

Hyderabad: The Employees Health Scheme (EHS) which is intended to provide cashless treatment to the State government employees, including the State government pensioners and their dependent family members through a network of empanelled hospitals of Aarogyasri Health Care Trust, in lieu of the present medical reimbursement system, does not seem to have taken off due to lack of proper coordination between the super-speciality hospitals and the government.

The government employees are not too happy with its implementation as the corporate hospital managements have turned down many cases saying that the tariff that was being offered by the Arogyasri Trust which is overseeing the EHS was too low. They claim that the package that was being offered for various procedures they feel was less even when compared to CGHS (Central Government Health Scheme). Knowingly or unknowingly majority of employees and their dependent families are knocking doors of the multi-speciality hospitals with the newly issued EHS identity cards only to get disappointed.

This, according to TGO organizing secretary Syed Saleemuddin, has left the government employees thoroughly disappointed. “With EHS yet to take off here, we are forced to go for reimbursement treatment. Government should quickly enter into agreement with these hospitals, lest questions will be raised over its implementation,” he said.

But Arogyasri Trust CEO K Dhananjaya Reddy denied any failure of the EHS. He said a deliberate attempt was being made to show this scheme in poor light. According to him, around 120 hospitals in twin cities have been treating government employees under the EHS. It is wrong to say that the employees are not able to make use of the cashless treatment scheme. “Yes there are certain issues with just a dozen odd corporate hospitals and efforts are on to resolve it,” he added.

Reddy said the trust gave pre-authorization permission for cashless treatment for 13,148 cases costing Rs 25 crore since it was launched. Rs 10 crore amount was paid so far as claims to these hospitals. Under EHS, 11.3 lakh cards have been generated covering employees, pensioners and their dependents.

A total of 209 hospitals in Telangana, both in private and government, have been empanelled for this scheme. Of these, 128 hospitals including 113 private ones gave treatment to employees under the EHS, he said.

Meanwhile, president of Telangana Hospitals and Nursing Homes Association T Narsing Reddy, stressed for the enhancement of medical package rates for government employees. The rates presently offered were slightly high than Arogyasri tariffs introduced to serve BPL families. He cited an example to make his point. A bare metal stent costing just Rs 10,000 would be used for cardiac operations in Arogyasri method. However, the government staff, who earn decently, prefer drug-eluting stent that costs between Rs 80,000 to Rs 1 lakh. In such a scenario, how will the EHS be implemented effectively without increasing tariffs, he asked.

When asked about the claims and counter claims being made by the employees and Argoyasri Trust, the officials admitted that there was some problem and discussions were held with employee unions, hospital managements to find a way out and minutes of the meeting were brought to the notice of the government to take a call on enhancement of package rates.

Meanwhile, the government has decided to allow the existing reimbursement scheme to be in vogue till March 31, 2015.

By: Mahesh Avadhutha