Guidelines Issued on using Insurance Funds

Issuing fresh guidelines on the management of the various health insurance schemes offered by the state and Uniongovernments, the state health department has directed the funds thus obtained should not be wasted on branded drugs. A circular issued by additional chief secretary (health) Rajeev Sadanandan said that patients availing reimbursement schemes should be treated using generic drugs provided by the Kerala Medical Services Corporation Ltd. "Insurance reimbursements are for the hospital in general and not for purchasing branded drugs for treating individual cases," he said.

If a required drug is not in the essential drug list and has to be purchased, then the treating doctor must prepare a request stating the reason why that specific drug is needed.This has to be approved by a committee comprising medical superintendent of the hospital or resident medical officer, treating doctor and the pharmacist of the hospital.It has also been directed that if there is a shortage of drugs supplied by Kerala Medical Services Corporation Ltd then the insurance funds can be used for the purchase of generic drugs from the essential drug list. From now on, funds under the Rashtriya Swastya Bima Yojana (RSBY) can be used for purchasing drugs for all patients of the hospitals and not just for the RSBY patients like it is being utilized now.

The health department has also stressed the need for restrictions on the use of insurance funds for unnecessary investigations outside the hospitals. Hence, the department has directed the hospital management societies and development committees to augment diagnostic and therapeutic facilities in the hospitals.