SHILLONG: Stung by a series of criticism over glaring loopholes in the Megha Health Insurance Scheme (MHIS), the Health Department on Thursday admitted that there have been lapses while disseminating the various segments of the scheme to the beneficiaries.
Convening a press conference at the Secretariat here on Thursday, Health Minister AL Hek along with Health Commissioner and Secretary, DP Wahlang, admitted that there were minor hiccups in the functioning of the scheme which is in its initial stage, and added that the government would rectify the problems.
“There were lapses while disseminating the various segments of this scheme to the people. It was our mistake in not declaring the package rate when the scheme was made known to the people,” Health Commissioner DP Wahlang admitted, while maintaining that the government has already declared that it will go according to the package rate and as per the standard treatment protocol.
Clarifying on the complaints made by the beneficiaries on the non-payment of the full amount due to the hospitals, Wahlang said that the payment is determined through the approved package rates already initiated in the Rashtriya Swasthya Bima Yojana (RSBY).
“The scheme is valid only for patients admitted into the general ward and anyone admitted to private ward will need to pay the excess out of their own pockets,” Wahlang stated, adding that the department has already instructed all the hospitals empanelled with this scheme to display the package rate on the hospital notice boards for the benefit of the people.
On the total number of beneficiaries, the Health Minister admitted that it was difficult to estimate the accurate number since the enrolment process is still not over.
The enrolment which started on March 18 will end on June 30.
Till date, 507 patients have benefitted from this scheme, 222 are still undergoing
treatment and the total amount claimed so far is Rs 16,55,056.
As many as 171 hospitals are empanelled with this scheme including a few hospitals outside the State in Vellore, Delhi and Guwahati.
According to the statistics presented by the Health department as on June 11, Nazareth Hospital had the highest claim status of Rs 8 lakh with 266 patients, while another 95 patients were undergoing treatment. Dr. H Gordon Robert Hospital was next with 91 patients and another 90 under treatment and total claims of Rs 2.9 lakh. Shillong Civil Hospital had a claim status of Rs 1.2 lakh with 29 patients completing their treatment and another 36 under treatment while Ganesh Das Hospital had claim status of Rs 9750 with 4 patients and 5 under treatment patients.
Hek mentioned that some private hospitals in the State were yet to be empanelled and the government is holding talks with these hospitals. He expressed hope that by June 30 many more hospitals will be brought under this scheme.
“The department has revised the scheme today (Thursday) and the new package rates will be prepared by June 30,” the Health Minister informed, adding that the government has designed performance-based incentives for the doctors and hospital staffs with an aim to motivate the doctors to dedicate more time at the hospitals.
Reacting to allegations that MHIS is a nomenclature of the existing centrally sponsored scheme RSBY, Wahlang said, “MHIS has only borrowed the technology, software and package rates of the RSBY which explains why the card was mentioned as RSBY card but the claims offered by the MHIS is much higher than that of the RSBY.”
Wahlang further informed that the MHIS is a combination of both RSBY and Universal Health Insurance scheme while explaining that under the RSBY scheme, the claims offered is only Rs 30,000 and that too only for the BPL families, but under the MHIS, along with the RSBY cover of 30,000, an extra claims of Rs Rs 1.3 lakh was announced, not only the BPL families but the APL families as well.
The Health Commissioner also informed that the department would approach IIM Shillong to study the system and initiate suggestions to the department on ways and means to improve the MHIS.