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Patients to feel pinch as private hospitals set to lose key surgical procedures

This move may result in prolonged waiting times in public hospitals and increased pressure on surgical staff and facilities in the government sector
01:07 AM Jan 23, 2025 IST | ZEHRU NISSA
patients to feel pinch as private hospitals set to lose key surgical procedures
Patients to feel pinch as private hospitals set to lose key surgical procedures___Representational image
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Srinagar, Jan 22: Four of the most commonly sought surgical procedures in the private sector may no longer be available to patients under the Ayushman Bharat Scheme from March 15, as per the J&K Government's latest policy shifts under consideration.

This move may result in prolonged waiting times in public hospitals and increased pressure on surgical staff and facilities in the government sector.

J&K Chief Secretary Atal Dulloo chaired the 9th Governing Council Meeting of the State Health Agency earlier this week. A government official said a few surgical procedures may now be reserved for public sector hospitals and private hospitals may not be allowed to carry out these under ‘Golden Card’, the Insurance Card of Prime Minister Ayushman Bharat Scheme.

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He said these changes are expected to come into vogue from March 15, 2025. This move is likely to have far-reaching consequences for patients, private hospitals, and the healthcare sector as a whole. The meeting aimed to review the performance of the SHA and discuss the way forward for the continuation of the AB-PMJAY and AB-PMJAY SEHAT schemes.

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Lap cholecystectomy, hemorrhoidectomy, appendectomy, and fissure in ano procedures may be reserved for government hospitals only, the official told Greater Kashmir. He expressed concern that the move will increase the workload on public hospitals, potentially leading to longer waiting periods for patients. “Patients will have dates for these procedures months ahead, as is the case for any procedure in our government hospitals which are so overloaded,” he said.

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A private hospital owner said the procedures that could be struck from the list of private hospitals account for 57 percent of procedures carried out by them. “In the past year, Rs 103 crore worth of benefits were provided through these procedures to patients,” he said. “Currently, the waiting period for tertiary care hospitals is approximately 52 days, which may increase to 4-5 months. This could lead to more episodes of pancreatitis and other complications, particularly for poor patients who cannot afford private healthcare if its not covered under insurance,” he added.

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In addition, it has been learnt that the package rates for private hospitals may also be reduced by 10%. Private healthcare providers have been demanding enhanced package rates at par with rest of India. “This reduction may not keep pace with inflation and the increasing cost of medicines, supplies, and salaries,” a private hospital owner in Jammu district said.

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Official Spokesperson SHA said no decision had been finalised yet and Government was in the process of weighing the impact of changes that are on cards. “As the new policy is set to commence on 15th March, the government needs to make decisions accordingly on whether to proceed with the insurance mode or the trust mode,” the spokesperson said. Further, the SHA said, some packages may be reserved for public sector hospitals only, but stressed that it was still “too early to say” whether that will happen in near future.

According to Sanjiv Gadkar, CEO of State Health Agency (SHA), the agency has made significant progress in processing claims under the AB-PMJAY and PMJAY-SEHAT schemes. Out of 3,36,859 claims submitted, 1,22,839 claims worth Rs 222.58 crore have been paid, while 3,198 claims have been rejected. This translates into one-third of claims been cleared by now. The SHA has been directed to hire an insurance company to manage the scheme, which may help streamline the process and reduce administrative costs.

The agency claimed it is also prioritizing high-end and emergency procedures, in addition to claims from private hospitals, to ensure the smooth operation of the scheme across J&K. CS stressed the importance of implementing the revised AB-PMJAY guidelines, particularly ensuring coverage for individuals aged 70 and above. He instructed the SHA to investigate and address the duplication of Ayushman Bharat Gold Cards issued based on different databases, such as NFSA and SECC. He also emphasized the need to strengthen the monitoring mechanism to prevent fraudulent activities by empanelled hospitals.

Furthermore, the CS directed the concerned officers to develop new guidelines for claim utilisation, ensuring the effective implementation of the free health insurance scheme. Additionally, he requested the creation of a portal for public hospitals to facilitate better management of fund transfers and utilization.