Sukhu govt. recommissions Himcare in state hospitals, caps reimbursement at actual treatment cost
Shimla, Sep 4
The Sukhvinder Singh Sukhu government has effectively recommissioned the Himcare health insurance scheme in state-run hospitals, while introducing tighter reimbursement norms to prevent inflated and duplicate claims under the scheme.
Through a notification issued by the Department of Medical Education and Research on August 27, the government has amended the Himcare reimbursement provisions for government hospitals and medical and dental colleges.
Reimbursement would now be restricted to the actual expenditure incurred or the defined package rate, whichever is lower.
The move is significant as the government seeks to strengthen Himcare within its own healthcare institutions while simultaneously tightening financial controls.
Under the revised arrangement, government hospitals and medical and dental colleges will provide cashless treatment to Himcare beneficiaries and supply all required medicines, consumables, surgical items and other materials needed for treatment.
The notification makes it clear that medicines, consumables, surgical items and other treatment-related requirements already available through the state government or National Health Mission budgets cannot be separately claimed under Himcare.
The decision assumes significance against the backdrop of concerns over exorbitant billing and irregularities in health insurance claims.
By linking reimbursement to actual expenditure or prescribed package rates, the government has sought to ensure that Himcare does not become a mechanism for generating claims beyond the real cost of treatment.
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The latest order also marks a shift towards greater reliance on the state’s own healthcare infrastructure for implementation of the scheme. The notification specifically covers government hospitals and medical and dental colleges; it does not extend the amended reimbursement provision to private institutions.
The move comes amid a wider government scrutiny of Himcare finances. The state government recently informed the Assembly that it had initiated a vigilance inquiry into alleged irregularities in Himcare and Rogi Kalyan Samiti (RKS) funds. The government has also indicated that alleged frauds and irregularities in the purchase of medicines and medical equipment would be examined.
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Thus, while the Sukhu government has moved to recommission Himcare through government hospitals, it has simultaneously imposed stricter financial safeguards, seeking to ensure that treatment claims remain linked to actual expenditure and that government-funded medicines and supplies are not claimed twice.
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