The employees’ health insurance scheme in Andhra Pradesh is at a standstill as 15 leading private hospitals in the state refused to enter into a memorandum of understanding (MoU) with the state government. The much hyped employees health insurance scheme aimed at providing cashless healthcare facilities to all government employees in Andhra Pradesh.

According to Dr Bhaskar Rao, president of All Super Speciality Hospitals Association (ASHA), already the private hospitals are facing losses with the existing Arogyasri Health insurance scheme as the package offered under this scheme is inadequate. Now again the government is pressurizing the private hospitals to agree for Employees health Insurance scheme on same lines as Arogyasri. This will make them loss-making venture and would deteriorate their health infrastructure. “For Arogyasri, a package was designed keeping the cost in mind. But the Employees health Insurance scheme is different and here patients may demand many things that can’t be ascertained in a package. And the government is not ready to understand that. Our cost compulsions don’t allow us to opt for the scheme,” says Dr Rao.

Major problem in this scheme is cost of diagnosis. Before admitting a patients diagnosis is done and based on report the patients are admitted. But in this scheme for employees, diagnosis will have to be done for free, and claims can be made only for those who are admitted as in-patients. In hospitals, out of 100 patients, only five may require admission but the cost of diagnosing for the remaining 95 can be very high.

In view of conflicting issues in the scheme the private hospitals have refused to be part of MoU to support the employees’ health insurance scheme. While on the other hand the government is pressurizing the hospitals to become part of the scheme but the hospitals are rejecting to accept the scheme in the present form.

However the officials from the government side say that though the government can forgo these hospitals but it is still keeping its options open and expecting to reach at an amicable agreement with these hospitals. “These are some of the best hospitals in the country, we just can’t keep them out as employees are keen as they often frequent these hospitals for treatment,” says an official at Arogyasri Healthcare Trust.

So far out of 252 empanelled hospitals, 125 small hospitals and nursing homes have signed and have become part of the employees’ health insurance scheme. The state government is planning to rope in more top class private hospitals so as to make the scheme a success in the state.