Bengaluru: Despite being situated in Karnataka’s capital — home to one of the state’s largest concentrations of govt employees — the Employees’ State Insurance (ESI) hospital in Indiranagar continues to report low bed occupancy, sparking concerns about underutilisation of resources and gaps in access to care.In 2023-24, the hospital’s bed occupancy stood at just 32.6%, up slightly from 25.8% in 2022-23 and 21.3% in 2021-22. The numbers were even lower during the Covid-19 pandemic in 2020-21, when occupancy dropped to 8.3%. Even before the pandemic, the hospital failed to cross optimal levels, recording 34.5% in 2019-20 and 35% in 2018-19 — far below the 70% benchmark required for additional central grants.This trend is particularly striking given Bengaluru’s large insured workforce, which should ideally translate into higher utilisation of ESI facilities. The issue, however, is not limited to the capital.Across Karnataka, ESI hospitals have struggled to meet the 70% bed occupancy threshold, resulting in the state losing over Rs 65 crore in potential grants from the Employees’ State Insurance Corporation (ESIC) between 2019-20 and 2023-24, according to the Comptroller and Auditor General of India (CAG) report for 2024. The report notes that if the occupancy rate in an ESI hospital is more than 70%, then the state govt is eligible to get an additional grant of Rs 200 per insured person in the state from ESIC.Mysuru has highest occupancyAmong the hospitals, Mysuru recorded the highest occupancy, followed by Hubballi. In contrast, facilities in Dandeli, Mangaluru and Belagavi reported alarmingly low utilisation, with occupancy rates falling to single digits during the period under review.Lack of ICUs, specialists The audit attributes the poor occupancy largely to systemic gaps — including inadequate infrastructure, shortage of equipment, lack of ICU facilities, and absence of specialist doctors.The absence of ICUs has had a particularly significant impact. As per Indian Public Health Standards (IPHS) guidelines, district-level hospitals are required to have between four and 12 ICU beds to cater to 5% to 10% of patients. However, none of the test-checked ESI hospitals in the state had functional ICU facilities.This has restricted clinical services. Following a Supreme Court ruling that bars hospitals without ICUs from performing major surgeries, even qualified surgeons in ESI hospitals have been unable to carry out such procedures — limiting the scope of care and likely contributing to lower patient footfall.Govt cites operational woesResponding to the audit findings, the Karnataka govt attributed the absence of ICU facilities to infrastructural, financial and operational constraints. It also cited delays by the ESIC in upgrading hospitals, along with challenges in augmenting existing facilities. However, the govt maintained that emergency and critical care services had not been compromised.The report also flagged poor utilisation of investments in medical and digital infrastructure. Projects worth several crores remain underused or non-functional, including Rs 5.3 crore spent on telemedicine services, Rs 7.7 crore worth of uninstalled medical equipment, and liquid oxygen plants set up during the Covid-19 pandemic that are currently non-operational.Free/subsidised careESI hospitals are govt-run healthcare facilities that provide free or subsidised medical care to workers covered under the Employees’ State Insurance scheme and their dependants. Injudicious referrals strain financesThe CAG report highlights that referrals to tie-up hospitals have placed a significant financial burden on the ESI system, accounting for 21% to 31% of total expenditure in recent years. Referral costs rose from Rs 105.8 crore in 2019–20 to Rs 140.1 crore in 2023–24.This trend has been attributed to inadequate infrastructure and a shortage of specialist doctors in ESI hospitals. In Davanagere, over 2,200 cataract patients were referred despite the presence of an ophthalmologist, while in Mangaluru, outdated ENT equipment led to 1,765 referrals. The audit also flagged lapses in the provision of medicines after discharge.
