Srinagar, Mar 14: The State Health Agency (SHA) Friday announced the slashing of services available to patients in private hospitals of J&K under the AB-PMJAY SEHAT Scheme.
The changes will come into effect starting Saturday.
An order issued by Chief Executive Officer SHA, Sanjiv M Gadkar on March 14 has reserved four procedures for public hospitals only.
These are Appendectomy, Cholecystectomy, Hemmoroidectomy, and Fissure in Ano.
The unavailability of these four common surgical procedures in private hospitals may end up with patients turning to government hospitals where Golden Card can be availed for these treatments.
However, that could in turn prolong waiting times in public hospitals and increase pressure on surgical staff and operation theatres in the government sector.
Many doctors believe that these procedures could have a waiting time of many months, the delay having a serious potential of worsening patient outcomes.
The order has also announced changes to Health Benefits packages (HBP) 2.2: no 10 percent additional package price that was previously applied to private hospitals will be applicable.
The rates private hospitals can charge will need to strictly adhere to HBP 2.2, sans the surcharges.
The rates have been further curtailed for Sub-District Hospitals and Community Health Centers, which have been permitted to bill just 65 percent of the HBP 2.2.
The hospital administrators have been directed to adhere to the changes that come into effect on March 15 and ensure a seamless transition.
The changes had been on the cards since the beginning of this year, aimed at streamlining the SEHAT scheme.
The government has also been mulling to change the mode of insurance scheme operation.
The CEO of SHA had told Greater Kashmir that the SEHAT scheme may be changed to trust mode which could eliminate the hurdles it faces in processing of claims and reduce the turnaround time.
On 23 January, Greater Kashmir reported on the possibility of four surgical procedures getting struck off from the list of services private hospitals could carry out under the SEHAT scheme.
Greater Kashmir on March 14 had also carried a story on frauds worth Rs 11.8 crore committed by private hospitals getting exposed.
The scheme gives a cover of Rs 5 lakh per family per year covering all medical and surgical conditions, including pre and post-hospitalisation expenses.
Unlike many insurance policies, it covers all pre-existing conditions for any family in J&K of any size.
The SEHAT scheme benefits are available in all public hospitals while private hospitals are empanelled, based on certain specified criteria.
