NEW DELHI: Learning from past experiences which saw private hospitals carrying out unnecessary medical procedures or showing fake surgeries under public health insurance schemes, the Centre has decided to reserve 40 per cent procedures under the PM Jan Arogya Yojana (PMJAY) for government hospitals only.
The mega health insurance initiative is being rolled out on Sunday. “We are reserving about 40 per cent of the 1,350 packages on offer for public sector hospitals,” said Indu Bhushan, CEO of the national health agency formed to implement the scheme.
He said beneficiaries could avail procedures like Caesarean sections, hysterectomies and mental health disorders requiring hospitalisation in government hospitals only. “The decision has been taken to ensure no unnecessary procedures are carried out and there is no possibility of fraud,” Bhushan stressed.
However, the decision has not gone down well with mental health experts. “Most of the diseases and conditions with which the government is not trusting the private sector with, fall in the mental health category, which is not justifiable. It looks like the government is not taking mental health conditions seriously enough even though those have been included in the overall packages,” said Mukesh P Jagiwala, psychiatrist and treasurer of the Indian Psychiatry Society.
Another psychiatrist said that hardly any government hospitals, including medical colleges, had enough doctors and other trained staffers to treat hospitalised patients.
“Which means those patients will be routinely turned away,” he said. Some others said that since the scheme is just being introduced, this restriction may be as the government does not have enough experience to analyse claims from private providers.
“Hopefully as they gain data and experience, this restriction will go,” said Soumitra Pathare, co-ordinator of the Centre for Mental Health & Policy.
“The reimbursements from PMJAY will provide additional funding for the DMHP programs in districts to expand,” he added.