Small and medium-sized private hospitals in Karnataka are issuing a stark warning: they might soon stop performing paediatric surgeries under the Rashtriya Bal Swasthya Karyakram (RBSK) scheme. The reason? A staggering ₹23 crore in unpaid dues that have been pending since 2017. Hospitals claim they have no choice but to consider legal action if these payments aren’t cleared promptly. This critical situation could also lead to them withdrawing from other state health schemes, including the Ayushman Bharat Arogya Karnataka (AB-ArK) program, jeopardizing vital care for children.
The core of this financial quagmire dates back to 2016. At that time, the State government introduced new procedure codes under RBSK, a health initiative primarily funded by the Centre under the National Health Mission (NHM). However, these new codes were added without explicit approval from the central government. Private hospitals assert that they proceeded in good faith, relying on the officially published codes to provide essential medical services to sick children between 2016 and 2018. Subsequent audits, however, highlighted the lack of central clearance for these codes, leaving a massive backlog of unpaid claims.
A Lingering Technical Glitch
Officials point to a “technical glitch” as the cause for the prolonged delay. They explain that the procedures were incorrectly listed on the portal of the Suvarna Arogya Suraksha Trust (SAST), which is the primary agency responsible for implementing state health schemes. The matter is currently under review by the government.
The RBSK program, initiated in 2013-2014, aims to enhance the health and development of children aged 0 to 18. Its focus is on screening young individuals for “4 D’s” — Defects at birth, Deficiencies, Diseases, and Developmental delays and Disabilities. The scheme originally covered 40 medical procedures, which later expanded to 104. Children diagnosed with covered illnesses are meant to receive free follow-up care, including early intervention at the district level and surgeries at tertiary hospitals under NHM. Crucially, if government hospitals cannot provide these services, they are to be made available through empanelled private hospitals.
The Blame Game: Who Is Responsible?
Hospital associations firmly argue that the State government bears the ultimate responsibility for these payments. “The State introduced these procedures, but they weren’t formally approved by the Centre. Hospitals performed these life-saving surgeries based on government notifications,” stated Pavan Kumar Patil, a representative from the Indian Medical Association’s Karnataka chapter and a member of the Karnataka Medical Council (KMC). “This lack of clarity on financial responsibility has created enormous pending dues, pushing hospitals to their breaking point. These payments must be released without delay. If we are forced to pursue legal action, the government will incur additional costs, including interest.”
Despite numerous meetings with SAST officials and persistent appeals to the government since 2018, the payments remain unreleased. L.H. Bidari, founder trustee of the Yeshaswini health scheme, highlighted the severe financial strain this delay has caused. “Many providers invested substantial resources to ensure children received timely and high-quality care,” he explained. His own hospital in Vijayapura has claims totaling over ₹54 lakh that are still outstanding.
Shared Accountability?
Harsh Gupta, Principal Secretary for Health and Family Welfare, acknowledged the long-standing issue. “This is a seven-year-old problem,” he noted. “Patients were admitted, and pre-authorization approvals were granted by the government. However, hospitals proceeded with the procedures even though they were aware that the additional procedures hadn’t been centrally approved. Therefore, responsibility rests with both parties.”
Mr. Gupta confirmed that the issue is under active review and will be presented to the State Cabinet. He clarified that if the Centre ultimately does not approve these additional procedures, the State government will be responsible for covering the expenses.