Kerala govt insurance schemes a non-starter for Covid treatment in private hospitals | Kochi News

KOCHI: In Kerala, almost 80% of patients had to pay out of their own pocket for Covid treatment in private hospitals. Only 8% availed the benefits of government insurance schemes and another 12% had private insurance.
Till June 30, 2021, almost 8.2% of the total population (29,24,166 people) had Covid infection and of that an estimated 4,38,625 required hospitalization with many requiring ICU and ventilator support. During the initial phase of the first Covid wave, Covid treatment was limited to government hospitals. However, from October, private hospitals were roped in for treatment and now 50% of Covid hospital admissions, mostly category C patients (mainly critical patients), are treated in private hospitals.

An analysis of hospitalization trends in southern states by Project Jeevan Raksha, a public-private partnership initiative involving Public Health Foundation of India (PHFI), that has been submitted to central and state governments shows that in Kerala, till June 15, only 34,755 had sought treatment in private hospitals under government schemes and another 51,102 made claims under individual health insurance schemes.
‘Kerala Covid management disappointing in second wave’
This clearly indicates that in Kerala preference of empaneled hospitals for direct payment admission is relatively higher understandably due to higher per bed realization or profit. More disturbing is that even people who had taken insurance cover seem to have been denied admission. Kerala government has failed to regulate admissions effectively. On the other hand, Andhra Pradesh and Karnataka have been successful in ensuring the maximum number of people having medical insurance schemes either government or private are able to leverage on the available benefits,” said Mysore Sanjeev, convener of Project Jeevan Raksha, which puts out monthly Covid projections for each state.
This despite almost 5.7% of the population having group or individual health insurance (non-government schemes) in Kerala, while in India, it is only 2.4%. Another, 41.5 lakh families (almost half of state’s population) are covered under Karunya Arogya Suraksha Paddhati (KASP), a healthcare scheme of the state government under which approximately 19 lakh additional families get the benefits of Pradhan Mantri Jan Arogya Yojana (PM-JAY) along with the existing 21.87 families.
“Kerala Covid management, especially in the second wave, is disappointing. It has neither controlled the virus spread nor effectively regulated empaneled hospitals in bed allocation for insured people (government scheme or private). People seem to be scared of getting isolated in hospitals due to non-affordability,” said Sanjeev.
However, an official with the state health agency said, “Majority of Covid treatment is in government hospitals and Covid treatment is completely free here for all. Only very critical patients were referred to private hospitals.”

Due to out-of-pocket expenditure, according to Project Jeevan Raksha, during the second Covid wave, hospitalization in Kerala was less than 15% while that in neighboring Tamil Nadu was around 30%. However, the number of people on ventilator support among active cases increased by three times in Kerala. On October 10, 2020, only 189 of 95,918 active cases were on ventilator support, which works out to only 0.2%, whereas on July 10, 2021, out of 1.15 lakh active cases, 707 people were on ventilator, which is 0.6% of total active cases – indicating that due to delayed hospitalization, the condition of more number of moderately infected people deteriorated, leading to them slipping into critical condition.
Kerala Private Hospitals Association (KPHA) secretary Dr Joseph Benaven admitted that almost 80% of the patients admitted to private hospitals paid out of pocket. “Almost 90% Covid patients to private hospitals are direct walk-ins. Not many patients covered under the government insurance schemes have been referred to private hospitals and there is ambiguity regarding the KASP scheme when it comes to Covid treatment. Realizing that the majority have to pay out of pocket, most private hospitals have tried to ensure that the patient’s health and finances are protected,” said Dr Benaven.
Though during the Covid peak government had issued an order bringing in price regulation after the Kerala high court intervened and said that all private hospitals will have to reserve 50% beds for Covid treatment, of which 25 % will be for KASP patients, the fact remains that only 281 of the 1,286 private hospitals are empaneled for Covid treatment under KASP. So far, the state health agency has received 71,484 KASP claims amounting to Rs 227 crore, of which more than Rs 100 crore has already been released.