Srinagar, Feb 01: The Jammu and Kashmir government has proposed to reserve four surgical procedures for public hospitals under Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (PMJAY) and may be excluded from private hospitals, officials said on Saturday.
The new policy, currently under discussion by high-level officials due to the misuse of certain packages, aims to address these concerns, although a final decision is yet to be made.
The procedures in question are lap cholecystectomy, hemorrhoidectomy, appendectomy, and fissure in ano are expected to be reserved for public hospitals barring private hospitals from offering them under ‘Golden Card,’ the insurance coverage mechanism of the PMJAY.
Sanjiv M. Gadkar, Chief Executive Officer, State Health Agency, J&K said there is some discussion going on that there are some packages which are being misused by the hospitals and those packages would be reserved in public hospitals.
“There are 1900 packages and some four packages would be reserved for public hospitals (which is a proposal) and that would not affect private hospitals,” he said.
In Jammu and Kashmir, there are a total of 251 hospitals empanelled under the PMJAY scheme which includes 133 private hospitals and 118 public hospitals.
“It is a free treatment which the government under the scheme is providing to the beneficiaries and we have implemented the scheme over the years,” Gadkar said.
The CEO SHA said that the government is fully aware that how many treatments or packages are being done and at what hospital.
“We have got fair data with us and we have analysed all that and the discussion is that we will reserve these four procedures in public hospitals only. There is no absolute decision as of now and it is at discussion level,” he added.
However, some private hospitals empanelled under the AB-PMJAY scheme have expressed concern over the government’s proposal to exclude certain surgical procedures.
A private hospital owner from Srinagar said these four surgeries form the bulk of surgeries, around 65 percent, in any peripheral or private hospital.
“By this decision, the patients will get a date for surgeries after several months or in a year in public hospitals as private hospitals which are doing these surgeries at present will no longer be able to cater to these cases,” he said.
He said some patients who can afford to pay in private hospitals will get their surgeries done at a certain cost and those who can’t afford will have to wait at public hospitals. “By that time patients have to deal with complications of the disease,” he said.
However, Gadkar said, “We are equipped enough to take care of that and private hospitals have nothing to do with that. It is a free treatment given by the government to the public. Patients would not face any problem.”
The AB-PMJAY SEHAT Scheme in J&K was in the news last year after IFFCO-TOKIO took an exit from the scheme with the result that the private hospitals faced payment issues for months.
AB-PMJAY guarantees cashless secondary and tertiary inpatient care for almost all health conditions to its beneficiaries. This ambitious scheme has extraordinary potential to protect people from serious health hazards.
Officials said they have been working on mission mode to ensure 100 percent coverage.
The Ayushman Bharat which includes Ayushman Bharat Pradhan Mantri Jan Arogya Yojana and AB PM-JAY SEHAT has transformed healthcare in J&K and these schemes have achieved more progress over the past five years.
J&K had no history of any public-funded health insurance scheme before AB PM-JAY and people had to bear huge out-of-pocket expenditure which was unaffordable. The facility offered cashless medical care, enabling people to approach the best healthcare institutions.
