Consider inclusion of four surgical procedures in pvt hospitals: HC directs H&ME

Srinagar, March 03: The High Court of Jammu & Kashmir and Ladakh has directed the Health and Medical Education Department to consider allowing four surgical procedures in private hospitals, which were initially proposed to be reserved for public hospitals under Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (PMJAY).
Earlier, various empaneled private hospitals, diagnostic centers, and dialysis centers sought directions from the High Court for the respondents for the extension of National Health Packages mentioned in the Office Memorandum dated April 6, 2022, under the AB-PMJAY Health Benefit Package Master 2022 in J&K.
The petitioners also requested an amendment to the “Request for Proposal” for selecting an insurance company for implementing Ayushman Bharat-Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) and Ayushman Bharat PMJAY-SEHAT in the Union Territory.
Additionally, the petitioners sought directions for including surgical procedures such as Appendectomy, Cholecystectomy, Hemorrhoidectomy, and Fissure in ano in the request for proposal.
As per the order it is submitted by learned counsel for the petitioners that Centre launched AB-PMJAY Scheme in Sep 2018, a flagship program that provides insurance cover up to Rs 5 lakh per family per year for secondary, tertiary care hospitalization.
The learned counsel submitted that the J&K government launched AB-PMJAY-SEHAT to provide free universal health coverage to all residents, including serving and retired employees and their families, with benefits equivalent to AB-PMJAY.
It further submitted that pertinently, the scheme was introduced to reduce catastrophic health expenditure and improve access to quality health care to people of J&K.
The order said that petitioner Hospitals/Nursing Homes/Clinics have been empanelled under ABPMJAY and the “request for proposal” further mentions that the above four procedures will be the reservation packages for public hospitals only.
“Learned counsel further submitted that the official respondents have decided to implement the Schedule of HBP 2.2 issued by NHA in J&K, however, Ministry of Health and Family Welfare (National Health Authority) has issued an office Memorandum dated 6th April, 2022 and the said HBP has been named as HΒΡ 2022,” it said.
It said that National Package has to be included by all the States to provide health care facilities to citizens through Empanelled Health Care Providers.
The government of Jammu Kashmir through its State Health Agency has issued a “Request for Proposal” for selection of Insurance Company for implementation of AB-PMJAY and ABPMJAY–Sehat based on HBP 2.2. (November, 2021) Scheme/Schedule, which has become redundant due to the issuance of AB-PMJAY Health Benefit Package Master 2022 and this scheme of 2022, has to be implemented in Jammu and Kashmir, as per Clause 5 of Office Memorandum dated 6th April, 2022/AB-PMJAY Health Benefit Package Master 2022.
It also said that the scheme of 2021 will affect health care benefits to the domiciles of J&K and will also cause huge financial losses to empanelled hospitals which include the petitioners.
“Upon taking up this case for hearing, Alla-ud-Din Ganaie, learned AAG, was requested to appear in this case. He appeared and accepted notice on behalf of the respondents,” it said.
According to the order regarding the nature of the grievance projected through the instant petition, the matter can be disposed of even at this stage by passing of appropriate direction which are not likely to prejudice the interests of the respondents.
The instant petition is disposed of at this threshold stage with the direction to respondents to consider the extension of the National Health Package mentioned in the Office Memorandum dated 6th April, 2022/AB-PMJAY Health Benefit Package Master 2022 in J&K.
The order said, accordingly, consider the amendment to the request for “proposal for selection of Insurance Company” for implementation of AB-PMJAY and AB-PMJAY-SEHAT in J&K so that domiciles avail benefits of the scheme at par rest of the country.
The respondents are also directed to consider the inclusion of surgical procedures as per the Office Memorandum in the request for proposal for selection of Insurance Company for implementation of AB-PMJAY and AB-PMJAY-SEHAT through empanelled petitioners, as the same constitute the most common surgical procedures needed by citizens living below poverty line who are not in a position to avail said services properly in the public hospitals.
“It is expected that respondents may have the consideration strictly as per the governing Yojana/Scheme before the award of contract to the selected Insurance Company(s),” the order added.
Earlier, the government had said that it had proposed to reserve four surgical procedures for public hospitals under PMJAY and may be excluded from private hospitals.
Officials had earlier said that the new policy, currently under discussion by high-level officials due to the misuse of certain packages, aims to address these concerns.