Swasthya Sathi puts state among top in health cover

Kolkata: Bengal's Swasthya Sathi covers 74.5% residents — among the highest in India for publicly-funded health insurance, according to a research report released in Kolkata on Friday.The report also flags that a Swasthya Sathi beneficiary incurs four times higher out-of-pocket expenses (OOPE) for drugs and diagnostics when using the scheme in private facilities compared to govt health institutes.
The excerpts released at a workshop by Pratichi at Salt Lake's Amartya Sen Research Centre are part of — "Health Financing Fragmentation and Universal Health Coverage" — a collaborative project between Imperial College, London and O.P. Jindal Global University, funded by UK-based National Institute for Health and Care Research.The Bengal leg covers a survey of 2,525 households covering 10,235 individuals across the four districts of Murshidabad, West Burdwan, Jalpaiguri and North 24 Parganas between June and Sept, 2024.Among those surveyed, 16.6% had used Swasthya Sathi. According to excerpts from the findings, a Swasthya Sathi beneficiary spends Rs 4,000 on average as OOPE in govt hospitals and Rs 16,300 at private hospitals.Findings further indicated that of those who used Swasthya Sathi, 70% used the scheme in private hospitals and 30% in govt hospitals. The report stated: "We find that among Swasthya Sathi users, OOPE was incurred particularly for drugs (mean Rs 6,700) and diagnostics (Rs 6,800)."It further pointed out that people who don't use Swasthya Sathi don't do so out of choice. "Some of the reasons reported for not using the scheme when hospitalised — apart from treatment taken at a govt facility — include issues related to provider behaviour and supply-side issues."These include concerns such as hospitals denying service, hospitals not being empanelled, services not being covered and long waiting periods. Among the 83.4% of Swasthya Sathi beneficiaries who did not use the scheme, 70% availed of treatment in govt hospitals and the remaining 30% in private hospitals.People who did not use the scheme in private hospitals had to shell out an average of Rs 2.9 lakh as OOPE, while those who chose not to use it in govt facilities paid Rs 3,400 as OOPE.The report also notes that outpatient (OP) care constitutes around 90% of OOPE in Bengal. Of the 1,067 OP episodes studied, only 43% sought medical care, mostly from private providers.Of the remainder, 12% received no treatment and nearly 50% opted for self-treatment, driven by perceived mildness of the ailment or a lack of money. The govt-private hospitals divide is starker for the 13.2% who aren't covered by Swasthya Sathi.The study suggests govt hospitals are the best option for these individuals due to a lower average OOPE of Rs 3,000. However, if those not covered by the scheme were to go to a private hospital, they end up shelling out an average OOPE of Rs 3.1 lakh. It calls high OOPE a nationwide problem.