Mandatory Medical Audit for Hospital Stays over 10 Days under Swasthya Sathi Scheme
Kolkata: The state health department has introduced new checklists aimed at ensuring the efficient use of Swasthya Sathi, Bengal’s universal health insurance scheme. The latest advisory from the Swasthya Sathi Samiti discourages hospitals from extending hospital stays for common medical problems and from performing additional surgeries beyond the primary planned procedure.
According to the advisory, any Swasthya Sathi patient who requires hospitalization for more than 10 days for common medical issues must now be referred to the scheme's medical audit team to assess the necessity of the prolonged treatment.
A state health official highlighted that hospitals frequently extend the stays of patients with general medical conditions beyond 10 days, which is not always necessary. This not only increases medical expenses but also exposes patients to higher risks of hospital-acquired infections, especially for patients with comorbidities, reports the Daily.
One of the officials told the Times of India, “The genuine cases will be considered once our medical team is satisfied with the doctors' explanation. We had to introduce this double-layer check to discourage foul play.”
Many of these extended hospitalizations for Swasthya Sathi patients are reported from smaller nursing homes on the outskirts. The official acknowledged that there could be legitimate cases, especially for patients with comorbidities, but emphasized that this could not apply to all patients.
The Swasthya Sathi scheme allocates Rs 3,000 per day per patient for medical management. Health officials have also noticed instances where hospitals have claimed for additional surgical procedures that were not part of the original treatment plan, a practice that will no longer be tolerated. Hospitals and doctors involved in such practices will face disciplinary actions, reports the Daily.
"We have always been informed in case a Swasthya Sathi patient requires a longer hospital stay. We welcome such scrutiny for ensuring judicial utilization of govt funds," said Peerless Hospital CEO Sudipta Mitra. Rupak Barua, MD & CEO of Woodlands Multispecialty Hospital and the president of AHEI (Association of Hospitals of Eastern India) also lauded the move stating, “Both the decisions are welcome. Hospitals should not exploit govt resources. If longer hospital stay is justified or an additional surgery is required, there is a need to follow a process.”
