The lives of hundreds of infants with serious congenital heart disease (CHD) is hanging in the balance as the National Health Mission (NHM) and the Sree Chitra Tirunal Institute for Medical Sciences and Technology (SCTIMST) are engaged in a war of words over reimbursement of medical bills for corrective surgeries done for the infants under the Rashtriya Bal Swasthya Karyakram (RBSK).
Since 2014, under the RBSK, a national initiative, thousands of children with congenital defects from across the country have undergone complex surgeries in tertiary care speciality centres such as SCTIMST and selected empanelled private hospitals in the State.
However, a change in terms of the MoU between SCTIMST and NHM and the latter’s refusal to blindly reimburse the bills produced by the SCTIMST anymore has resulted in a stalemate wherein several children with serious congenital defects are now being turned away.
Matters reached a head last week, when two infants from Tamil Nadu with critical CHD who required emergency surgeries were refused admission at the SCTIMST. The infants had to be admitted to the newborn unit at SAT Hospital and an interim procedure done to buy time.
Under the original MoU, the NHM had agreed to pay treatment bills at rates fixed by the SCTIMST. However, issues began when the RBSK introduced package rates for various procedures.
“The issue was flagged by the NHM in 2018 that bills can be paid only as per the treatment package rates. We then did a cost comparison analysis and found that for almost every surgical procedure, the rates charged by the SCTIMST was 20-100% higher. However, all our empanelled private hospitals are willing to do the surgeries at the RBSK package rate,” a senior NHM official told The Hindu.
In 2018, over 900 surgeries were done under the RBSK, in 2019 over 1,200 and this year till November over 900 surgeries were done. Since January last, the NHM has been refusing to foot the bills submitted by the SCTIMST, unless they matched the RBSK package rates.
“The outstanding payment due from the RBSK to us now stands at ₹20 crore, which has pushed the SCTIMST into dire straits. We are now under severe pressure from our suppliers of surgical consumables. We have been doing very complex paediatric surgeries under the RBSK,” a senior doctor at the SCTIMST said.
“The SCTIMST has not been able to justify its high cost of procedures when corporate hospitals are willing to go by the RBSK package rates,” the NHM spokesperson said.
Another outstanding issue that the NHM has brought up is regarding the treatment of children from other States. The RBSK is run with Central-State share in a 60:40 ratio. The NHM is utilising ₹10 crore from the State Plan fund and ₹15 crore from the Centre, which is the Central share for offering free treatment to children within the State.
“Almost 40% of the children treated under the RBSK at the SCTIMST are from other parts of the country. This is a drain on our resources because all States have its own RBSK funds at their disposal. We have now paid ₹10 crore out of the pending payments to the SCTIMST for cases from within Kerala at the RBSK package rates,” the NHM official said.
When the MoU between NHM and SCTIMST was renewed in October this year, the latter dropped a chunk of the cardiac procedures under the RBSK as well as all neuro procedures.
“This situation has been quite painful for me because if we turn these infants away, 90% will not survive. There has to be some solution or the RBSK should set up a Central fund so that all children from across the country can be helped,” Baiju S. Dharan, head of cardiac surgery, SCTIMST, said.
