PANAJI: The state government has decided to float fresh tender under the Deen Dayal Swasthya Seva Yojana inviting bids from insurance companies by the first week of February upon conclusion of the ongoing exhaustive exercise of reviewing the scheme in its entirety.
In a move to douse the rising discontent among the 43 private hospitals empaneled under DDSSY, state government has also decided to maintain status quo on the ‘upgrade clause'.
The review of the scheme is likely to be completed by January 15 and though the existing scheme has been utilized as the base document, certain major modifications and enhancement of packages and terms are likely to be affected in favour of the 43 empaneled private hospitals.
The decisions were adopted by the state government during a crucial meeting of DDSSY stakeholders with Chie Minister Manohar Parrikar on Wednesday afternoon at the Secretariat in Porvorim.
It may be recalled that all 43 empaneled private hospitals had threatened to back out of the present format of the scheme citing economic unviability and had requested the CM to maintain ‘status quo' till formal review scheme.
Accordingly, the state government has now agreed to maintain status quo vis a vis the upgrade clause in the scheme and the changes pertaining to room rent have been withdrawn.
Sources at the Secretariat disclosed that the scheme will continue to be implemented in its original format and that private hospitals can upgrade facilities and services with the written concurrence of the patient.
As per the ‘upgrade clause', explained in point 5.7 of the Memorandum of Understanding signed by the stakeholders, private hospitals were permitted to offset losses incurred by them due to the low rates allotted for procedures under the DDSSY by charging the patients for the difference in package, if the patients sought for an upgrade un accommodation and if they expected higher quality of services.
The clause as included in order to allow the empaneled private hospitals to balance their expenses.
However, following the sudden amendment of the clause by the government and the insurance provider, private hospitals have been unable to balance the financial aspect of the scheme.
When contacted for further information about the scheme, DDSSY government consultant Dr Balkrishna Pai informed that till date, 21,000 cases have been taken up under DDSSY.
"Of these, 19,000 claims have been settled with an amount of Rs 74 crore being approved. The remaining claims are either pending approval or have been rejected owing to non-satisfaction of various queries raised thereunder," Dr Pai informed.
Of the total Rs 74 crore approved, Rs 65 crores has been released under the scheme to the 47 hospitals.
Breaking it down further, he explained that Rs 18 crore has been paid to government hospitals for 2,848 cases while Rs four crore amount is still under process. Private hospitals, on the other hand, have handled 12,000 cases for which an amount of Rs 34 crore has been paid to them. Payment of Rs 19 crores due to private hospitals is under process.
It was informed that approximately Rs 100 crore has been paid till date to the insurance companies, United India Insurance Company (insurer) and Paramount Health Services (TPA) Pvt Ltd, to make provisions under DDSSY. Of this, an amount of Rs 82 crore has been paid as premium apart from service tax and GST.
"The government pays a premium of Rs 3,300 in addition to GST and service tax on each DDSSY card availed by a Goan resident," Dr Pai stated.
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DDSSY MONEY AND
CLAIM SETTLEMENT >>
TO INSURANCE CO
* Rs 100 crore (including Rs 82 crore premium as well as GST and service tax)
CASES TAKEN UP
* 21,000 (since inception)
SETTLEMENTS
* 19,000 claims
CLAIM APPROVAL
* Rs 74 crore
GOVT HOSPITAL SHARE
* Rs 18 crore to four for handling 2,848 cases
PVT HOSPITAL SHARE
* Rs 34 crore to 43 for handling 12,000 cases
