Corruption bug seems to have inflicted State health scheme increasing the health bill by Rs. 350 Cr

By: Ashwin Aghor and Vivek Bhavsar

Mumbai: The disease of corruption is finally threatening to afflict an otherwise healthy and successful free health insurance to more than 80% of its population since past seven years under Mahatma Jyotiba Phule Jan Arogya Yojana (MJPJAY). Everything was going smoothly till the scheme was being implemented at a premium of Rs 640 per family. However, the bad bug of corruption seems to have caught up with the scheme as it raising the premium amount to Rs 797 crore, a straight away increase of Rs 350 crore burden on the state exchequer.

Under the MJPJAY around 2.23 Crore citizens of the state at present are being provided free medical treatments under this mass insurance scheme at empanelled public as well as private hospitals.

The scheme implemented in Maharashtra has been one among the best and most successfully run mass health schemes in the country since inception. The scheme is being implemented by the government owned insurer – National Insurance Company (NIC) since 2012.

However, the fresh tender floated to select an insurance company in September this year has opened a can of worms. The bids for the tender were opened on December 17, 2019. Interestingly, the lowest premium bid was Rs 797 per family. This according to highly reliable sources in the state health ministry will put an additional financial burden of Rs 350 Crore on the state exchequer.

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The new tender document has some modifications over the previous one in terms of change in criteria of hospital empanelment and de-empanelment. The changes have done more harm than good in terms of making these conditions more relaxed. While the existing scheme has had stricter empanelment criteria which permits only good quality hospitals to be a part of the scheme, the new hospital empanelment criteria poor quality hospitals to be empanelled under the scheme.

Further, the de-empanelment criteria for debarring a hospital for committing fraud has also been relaxed. Under the new scheme, it would not be easy to de-empanel a hospital founding guilty for fraud as the tender conditions provide multiple chances to the hospital to indulge in malfeasance before any proceedings can start to de-empanel it. The existing scheme, on the other hand, has strong penalties and a good de-empanelment clause which creates deterrence among hospitals indulging in wrong practices.

When it comes to implementation of Government mass health schemes, Maharashtra has so far been one prime example which has seen minimal fraud in such schemes owing to strong fraud mitigation practices which create fear among wrongdoers. The new tender however, has done away with these good clauses. More changes on similar lines in the new tender have weakened the scheme and made it more prone to fraud and abuse while also increasing the state’s expenditure by Rs 350 Crore.