Srinagar: The Jammu and Kashmir government’s proposal to cut four surgeries from the list of Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) has sparked concerns among patients and private hospitals, who cite the four procedures comprise the bulk of the cases they do on the golden card scheme.
The apprehensions about the scheme rose on January 19 when Chief Secretary, Atal Dulloo, while chairing the ninth Governing Council Meeting, hinted at removing these four surgeries from the scheme.
Dulloo directed setting up a committee under the chairmanship of Director General Codes with other members to review the extent to which each package needs to be tweaked for the overall benefit of the public.
Sources said the four surgical procedures proposed to be removed from the scheme include cholecystectomy (removal of the gallbladder), haemorrhoidectomy (haemorrhoid), sphincterotomy (fissure in ano), and appendectomy (appendix). These procedures will be kept available at government hospitals as has been the practice for years.
Health experts and patients said the change in the free health scheme will harm healthcare as it will increase waiting time for their treatment and patient rush in government hospitals and incur a monetary burden on patients as they will prefer private hospitals to wait for months at government hospitals.
The hospitals empanelled with the State Health Agency (SHA) say the tweak will lead them to financial losses and compel them to charge money from patients for the treatment they are doing free on the golden card.
“In the year 2024, we did 114,000 surgical procedures, among which more than 65 per cent comprised surgeries like gallbladder, haemorrhoid, and appendicitis. But the government’s proposal to delist four surgical procedures and tweak the budgetary support will majorly hit patients and also the health centres,” said a spokesperson of the Private Hospitals and Dialysis Centres Association.
The SHA’s Chief Executive Officer, Sanjeev Gadhkar, said the scheme provides 2300 procedures that the empanelled hospitals and health centres can do. “Removing any procedure will not impact the scheme,” he told ETV Bharat.
The chief secretary also gave a slew of other directions, including hiring a new insurer for the upcoming cycle (beyond March 14, 2025) after the last insurance company backed out before the three-year contract time, ensuring coverage of 70 years above, checking for duplication of golden cards, and using an efficient monitoring mechanism to weed out any chances of fraud by empanelled hospitals.
The association has threatened to pull out of the scheme from March 15 as the decisions taken in the General Council Meeting “are not in our interests.” “The authorities must show seriousness and revise rates for dialysis patients, release their pending payments, and make no tweaks in the budget and four surgical procedures. The Union Government has enhanced the budget for the Ayushman Bharat scheme by 24% to 9406 crores, but the Jammu and Kashmir government is planning to tweak the budget,” the spokesperson said.
Gadkari said that the scheme is performing fine in Jammu and Kashmir as Rs 222.58 crore has been paid to the empanelled hospitals for the genuine claims. “Out of the total claims of 336,859 submitted to SHA, 122,839 claims worth Rs 222.58 crore have been paid. 3198 claims were rejected for their ingenuity,” he said.
More than 85 lakh people in Jammu and Kashmir have been issued golden cards to avail of the scheme. AB-PMJAY is a free health scheme where the government bears the hospital, medicine, and doctor’s expenses for a patient. It was launched by Prime Minister Narendra Modi in 2018 to provide health insurance up to Rs 5 lakhs to all residents of India.
Minister for Health and Medical Education Sakeena Masood Itoo told ETV Bharat that the four procedures incur the majority of budgetary costs on the government, though no decision has been finalised yet about removing any procedure.
“The government has not taken any decision yet about the removal of any procedure from the scheme. If the chief secretary has formed a committee about the tweaking package or budget, the file will go through my desk. And the government will take a final decision,” she said.
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