Bengal chief minister Mamata Banerjee said that the state government has spent Rs 12,000 crore for the Swasthya Sathi scheme and that it has brought a revolution in the health sector, but the reality at private hospitals in Kolkata is different.
“We provide health insurance under the Swasthya Sathi scheme without any restriction like the income limit of that family,” Mamata said at the foundation-laying ceremony of Narayana Health City. “At the same time, the Swasthya Sathi card is registered in the name of a lady member of that family. These make the Swasthya Sathi scheme unique in the country.”
She added, “My government has brought revolution in the health sector of the state. We provide treatment and medicines totally free of cost. We are really proud of that.”
She said that the scheme covers 9 crore people.
It is true that many poor patients have had life-saving procedures thanks to the Swasthya Sathi card. A woman working as a maid in Kolkata had stents placed at a leading charitable hospital in the city recently, thanks to the Swasthya Sathi card.
The hospital initially refused, but later relented when the woman said she simply had no money to pay for the procedure.
However, many private hospitals in Kolkata either do not accept the Swasthya Sathi card or accept it with conditions. As per the official website, the scheme provides basic health cover for secondary and tertiary care up to Rs 5 lakh per annum per family.
An executive working at the Priyamvada Birla Aravind Eye Hospital, Elgin Road, said even a basic cataract operation is not covered under the Swasthya Sathi card and that many costs are not covered under the scheme.
“Retina surgery can be done via the card if approved by the Swasthya Sathi counter of the hospital,” the executive told The Telegraph Online. “The patient first needs to get himself checked by the doctor, the cost of which is not included in the Swasthya Sathi card, and then needs to perform additional tests which are recommended by the doctor, another cost not covered by the Swasthya Sathi card. Then, the reports need to be approved by the Swasthya Sathi counter, which, if approved, the cost is paid by the authorities.”
At Desun Hospital and Heart Institute in south Kolkata’s Kasba, the card can be used for open heart surgery, with conditions.
“Swasthya Sathi card can be used for open heart surgery in the hospital but the card will only cover the medical expenses,” an executive at the hospital said. “For example, for an open heart surgery, there are extra expenses of blood cost which are not covered, which falls between Rs 10,000 and 12,000, and the costs of doctor fees and tests are also not covered.”
Some hospitals have stopped accepting the card for major surgeries.
An executive from Phoolbagan’s Charring Cross Nursing Home Pvt Ltd said: “Yes, the Swasthya Sathi card is accepted in our hospital but not for all purposes. I have seen it accepted for small operations like gallbladder stone, but prior to that, doctor tests and check-ups are mandatory in our hospital, the cost of which is not covered. All big operations and surgery via the card were closed and stopped years back.”
Some hospitals do not accept the card, despite the Swasthya Sathi website mentioning their name as “active hospitals.”
An executive from one such healthcare hub, Green Park Nursing Home situated at Mukundapur stated, “No, we do not accept Swasthya Sathi card in our hospital as it is not allowed. Ever since I have joined this hospital, I have not seen the use of this card. If the official website mentions the use of this card, then maybe it was accepted prior to lockdown, but post that, it is not accepted.”
The situation is similar in Beniapukur’s Recovery Nursing Home.
“The card doesn’t work here, it was never accepted. Maybe the website is showing our hospital’s name, but we have never accepted the card,” one executive said.
Smaller hospitals with limited infrastructure accept the card, but not for major surgeries.
“We are a C-grade nursing home with 10 beds,” said an executive of Gay Land Nursing Home situated at Joka. “We accept Swasthya Sathi card, but there are certain permissions, and it cannot be used for all the treatments. It is not used for major operations. Gallstone and a few orthopaedic treatments can be treated via this card.”
Contacted by The Telegraph Online, Bengal’s junior minister for health and family welfare Chandrima Bhattacharya said the card is bound to be accepted.
“There is a number in every Swasthya Sathi card which the patients can dial in case the hospital is not accepting the Swasthya Sathi card. It is bound to be accepted and if not we will address the query. It is not possible to not accept the card in the state,” Bhattacharya said.
The Telegraph Online called up the helpline number provided in the Swasthya Sathi card. The person who answered the call said the inclusion of the hospitals under the scheme depends on if they have a dedicated Swasthya Sathi desk. If not, it means the hospital doesn’t accept the card.
“Even if the hospital name is mentioned on the website, the hospital has to be active by us,” the person on the help line said. “There must be a Swasthya Sathi desk in the hospital and if it is not there then the hospital is no longer under us. As a patient, one must confirm if the desk is present in the hospital. If the desk is still refusing to accept the patient then the person admitting the patient must stand in front of the desk and call us to raise a complaint.”
Others blamed the government’s fixed packages for surgeries.
“Swasthya Sathi card is not accepted in many hospitals in our state,” said Dr Subarna Goswami, additional general secretary of the All- India Federation of Government Doctors’ Association and deputy chief medical officer of health in the district of Purba Burdwan.
“The government is not taking any steps. The package of different surgical procedures in the scheme is poorly designed, low in comparison with the market rate. Many of the hospitals and doctors are not satisfied. And the government did it without any bilateral talk with them, that's why it actually failed. And in the coming days, more and more hospitals are going to refuse the card,” he added.
Government hospitals provide treatment for free, but the Swasthya Sathi card does offer additional benefits there.
“Swasthya Sathi card can be used for every treatment in government hospitals, but the approval and reimbursements take some time,” a doctor from Serampore Walsh Super Speciality Hospital in Hooghly told The Telegraph Online. “But, eventually, it is paid. The authorities check the record and history of the patient. Sometimes the authorities also call the patient’s relatives to do a background check to cross-verify, and if they are satisfied, it is passed.”
At SSKM, Dr Bipresh Chakraborty, a senior resident doctor of gastroenterology, said: “During the admission of the patient to the hospital, if they have a Swasthya Sathi card, there are certain facilities which they get in addition. For instance, there are cabins that cost around 2.5k per day. If the patient has a Swasthya Sathi card, they turn it in for free. Rest all treatment is already free in government hospitals, so no difference.”