There has been one major issue being faced by hospitals like ours in management of patients who come with the smart card.
The reimbursements alloted under the RSBY Program for hospitals is the minimum costs that any clinical establishment spends.
Kindly see the following clinical scenarios. They are quite common in settings such as ours.
1. KP, a 15 year old boy is brought to the Emergency Department with a history of loss of consciousness since one day. On taking detailed history, we found out that the boy had been receiving partial treatment from a Registered Medical Practitioner (quack) in his village for fever since the last 10 days. On further examination, we find that he is going into respiratory depression and would need to be put onto the ventilator. He has Plasmodium Falciparum in his blood. He is in sepsis as he appeared to have developed aspiration pneumonia. He is also anemic which needs blood transfusions. The costs of treatment are much higher than what the RSBY Scheme will pay the hospital. Most probably, KP was having malaria. He was not given anti-malarials by the quack. If he had come straight to us at least 2-3 days since developing fever, we would have treated him in outpatient and would not have ended up with all these complications.
2. JP, a 25 year old housewife, pregnant for the second time had been trying for home delivery since early morning. She has reached NJH at around late evening, saying that she cannot feel any fetal movements. We diagnose rupture uterus. And to our horror, a midline vertical incision on the abdomen. Her previous delivery was by Cesarian section. Her second delivery should have been in a hospital with all full fledged facilities. She has ended up in this situation because of trying to deliver at home. The cost of an elective Cesarian section or a V-BAC (Vaginal birth after C-section) in NJH would have been much cheaper. Her husband says that the family has a smart card.
3. MS, a 20 year old young male with a snake bite was brought to emergency 8 hours after suffering a snake bite. He is from the nearby village. It is obvious that it is a krait bite. The patient is already in respiratory failure and is intubated fast. The Anti Snake Venom is rushed in. On asking why it took so much time to reach, the relatives tell us that they were trying black magic (jhad phuk). MS would not have been this sick had he come early. Now, the costs and the duration of care has increased exponiantially and his chance of survival is less.
I could go on and on. Basically, these are patients with the following characteristics –
a. The reached the hospital late on account of their slack attitude.
b. They were being treated elsewhere by unqualified healthcare personnel.
c. They have received treatment which has endangered their life and brought in complications, which would not have been there if they had come straightaway.
The million dollar question is whether we should take them under the RSBY scheme. I would like to hear suggestions and opinions . . .