Sree Chitra Tirunal Institute for Medical Sciences and Technology (SCTIMST), one of the country's prominent centres for medical research and also its most affordable referral hospital, will considerably cut free treatment for below poverty line (BPL) families and end subsidy for Above Poverty Line (APL) families from December 1 this year.

From then on, possessing a BPL card alone will not be enough to claim free treatment at SCTIMST. The card-owning families will also have to prove that they are deprived on a large number of counts before they are made eligible for free treatment. If they fail, these BPL families will get just 30 per cent discount on treatment costs, a benefit till now extended to APL families.

In other words, BPL families that enjoyed free treatment till now will henceforth be divided into two: Category A (100 per cent free) and Category B (30 per cent subsidy). As it stands, there are four categories of patients: Category A (BPL families, all of them eligible for 100 per cent free treatment); Category B (APL families who get 30 per cent subsidy); Category C (APL families who get 10 per cent subsidy); and Category D (fully paid category).

From December 1, the APL subsidy is out and treatment subsidy will be limited to just BPL families, and even these families will be divided into two, one eligible for free treatment and the other eligible only for 30 per cent subsidy.

An interview will be conducted to separate the BPL patients into these two categories. The SCTIMST governing council has laid down nine poverty parameters, and for a family to be eligible for free treatment it should be able to make a tick mark against at least seven of the nine deprivation indicators.

The SCTIMST has published only five of the conditions. The remaining four are kept under wraps because, as a top official said, the institute did not want patients to come prepared for the interview.

The five disclosed deprivation requirements are: One, certificate from local body declaring that the patient does not own a house; Two, certificate from local body declaring size of land owned by the patient's household; Three, widow certificate; Four, medical records of a chronic patient in the family (mentally retarded person/disabled individual/cancer patient/HIV afflicted/dialysis patient/bedridden member in household); Five, SC/ST certificate and proof of no earning in the family.

There is a concern that the conditions have been designed to deny even the very poor free treatment. Under the new conditions set by the SCTIMST, it is not enough to be poor in income terms. To get free treatment, the patient should be from a BPL household that had already lost its breadwinner. Even this is not enough. The household should also have someone with chronic illness like cancer or HIV, or disability. And even then, if this patient with a lost father and dying relative happens to own the one-room leaking mud house, she could in all probability be disqualified.

Such a patient is then eligible only for a 30 per cent subsidy. Meaning, a common procedure like angioplasty, which was all this while free, will now cost a disqualified BPL family Rs 16,100, an MRI abdomen will now cost Rs 4,981, a peripheral doppler will cost Rs 1,078, and the patient will have to shell out Rs 448 even for something as common as an abdomen ultrasound scan.

The SCTIMST contention is that it is trying to weed out the extra numbers in Kerala's BPL list. The institute being a central institution, it has to adhere only to the central list. If there are over 40 lakh people in the state BPL list, it is just 21 lakh in the centre's list.

Nonetheless, the new SCTIMST conditions have the potential to keep out even those in the central list.

There was also a hint that the discounts have become burdensome as it was fully borne by the institute. In the official communique that announced the new socio-economic categorisation, the SCTIMST said: “The entire burden of subsidies is met from the internal revenue of the hospital and is not supported by any government or other schemes.”