TV
Odisha’s state sector hospitals continue to be poorly managed and have hardly acquired the level of expertise and professionalism required for addressing critical cases. Each Hospital up to the Medical College shows mismanagement in plenty. A quick look at the existing infrastructure reveals that all government hospitals put together have a combined bed strength of 18,365 of which the three medical college Hospitals at Cuttack (1707), Berhampur (1062) and Burla (982) account for 3751; Capital Hospital has 557, Govt Hospital at Rourkela 209, and District Hospitals 5166. Sub Divisional Hospitals offer 1527 beds, while Community Health Centres have 5817, Primary Health Centres 1026 and other Hospitals 312. In the last six years, 8 new Medical Colleges have been established in the state at Balasore, Baripada, Bolangir, Koraput, Puri, Keonjhar, Sundargarh and Kalahandi. Two PG Institutes are coming up in Capital Hospital and Cuttack Cancer Hospital.
Health Budget for 2024-25 provides for Rs 8721 crores for state sector schemes (SSS), Rs 5129 crores for Administration and other expenses and Rs 3520 crores for capital expenditure. The previous year’s provision under state sector schemes was Rs 5913 crores and actual expenditure in 2022-23 on state sector schemes was Rs 4806 crores.
As per the prevailing arrangements under the Biju Swasthya Kalyan Yojana ( BSKY)the services that are provided to patients under Universal Health care up to the Medical College Hospital level include(i) Free drugs (ii) Free Diagnostic (Pathology, Radiology, and Biochemistry, Ultrasonology, Histopathology charges), (iii) Free Cancer Chemotherapy, (iv) Free Dialysis charges, (v) Free Operation Theatre charges, (vi) Free ICU charges.
As per official information, 5.24 crore people availed of the government health facilities in 2021. In 2022 the number increased to 6.54 crore and to 7.43 crore the next year. In 2024, till the middle of October, 5.56 crore people have availed of the service offered by 8530 government hospitals. The government have empanelled 979 private hospitals (787 hospitals in Odisha and 192 hospitals outside Odisha) where referred patients can be treated at rates approved by the government for different specialities numbering 27 including one known as an unspecified surgical package for which the approved rate is Rs 5 lakhs for male patients and Rs 10 lakh for females. The state has 3.56 crore BSKY Cardholders covering 99.09 lakh households. While only cardholders can get them referred to private empanelled Hospitals, anyone can get treated in Government Hospitals free of cost.
The number of patients treated in empanelled private Hospitals under the BSKY has been increasing. It has gone up from 1.41 lakh in 2021 to 6.48 lakhs in 2022, to 13.14 lakhs in 2023 and has reached 15.13 lakhs by the middle of October of 2024. Total reimbursements have increased from Rs. 252 crores in 2021 to Rs 1484 crores in 2022 and Rs 2880 crores in 2023. In 2024, till the middle of October, the reimbursement has been Rs 3181 crores. The total reimbursement amount for 2024 would exceed Rs 4000 crores. This figure of Rs 4000 crores accounts for 46% of the total outlay of the state sector schemes of the Health Department and is for the treatment of over 15 lakh persons in the state—just 2.7% of the total number of persons who make use of government’s hospital facilities. In case 30 lakh patients take treatment in empanelled private hospitals, the entire budget outlay under state sector schemes would be utilised leaving no funds for any other activity of the health department. Apart from this, the other implication relates to a more critical area --- capacity building in the government sector hospitals to handle critical cases involving high-end surgery.
The state hospitals are presently extremely ill-equipped to treat such cases. Since the state is now having more Medical Colleges and in future, we may even have one for each District there will be many more medical students and teachers who will need exposure to handling critical cases to gain professional experience. At present very little is being done in government hospitals and the teachers and students get little opportunities to experience high-end surgical procedures and ancillary treatment. It is unfortunate that only one Government Hospital in the state—SCB Medical College, Cuttack-- is doing open heart surgery on a limited scale—four cases per week. Ideally, even a few District Hospitals should have such a facility. We could have by now put in place a satisfactory arrangement in all three medical colleges and in Capital Hospital for regular open-heart surgery and paved the way for such facilities in the new medical colleges. With an out-of-the-box approach such arrangements should have been possible. Almost every comparatively simpler surgery procedure should have been handled in District Hospitals without referring such cases to private hospitals.
As things stand now, the arrangement is only accentuating the professional inadequacy of both government doctors and hospitals. This needs to be rectified through a time-bound programme that should comprise setting up of essential hospital-level infrastructure, hiring willing professionals on contract from other places, payment of liberal incentives to all doctors and paramedical staff for such surgery procedures and provision of adequate funds with financial powers to the team head to ensure uninterrupted surgery schedule. To prevent avoidable leakage in the present arrangement, cases to be referred to private empanelled hospitals should be subjected to closer scrutiny. The financial ceiling for unspecified surgical package should be immediately pegged at three lakh rupees irrespective of the gender of patients and reference to private hospitals under this package should be only after scrutiny by a high-level technical team. The present BSKY Dashboard does not disclose Hospital-wise disbursement nor does it disclose the speciality-wise disbursement. These deficiencies should be immediately addressed.
(DISCLAIMER: This is an opinion piece. The views expressed are the author’s own and have nothing to do with OTV’s charter or views. OTV does not assume any responsibility or liability for the same.)
