NEW DELHI: Worried about the misuse of some treatments offered under the Centre’s flagship health scheme Pradhan Mantri Jan Aarogya Yojana (PMJAY), the government has decided to rope in country’s top health research agency— Indian Council of Medical Research to develop a standard treatment protocol for nearly 70 of the most availed packages.
The conditions for which these specific protocols will be developed include caesarean section, hysterectomy, chronic obstructive pulmonary disease, pneumonia, angioplasty, chest pain, cancer of various types, management of enteric fever and breathlessness in children among others.
Officials of the National Health Authority that implements the PMJAY said that a memorandum of understanding will soon be signed with the ICMR and the department of health research under the Union Ministry of Health Research for this.
“We are hoping that the protocols developed help not only the scheme but also act as a guide to thousands of hospitals and clinicians across the country,” said Arun Gupta, executive director with the NHA.
The procedures for which protocols will be developed include top procedures under the PMJAY as well as some others identified by experts that are availed by large populations frequently.
PMJAY, which was launched last year to provide cashless hospitalisation benefit of up to Rs 5 lakh to nearly 40 per cent of the country’s population, has also reported instances of fraud similar to the ones noticed in other state-run health insurance schemes earlier.
The figures by NHA say that by August this year, notices had been issued for irregularities to nearly 338 of about 18,200 empanelled hospitals and over 110 of them have also been de-empanelled.
“In most cases, there was evidence that hospitals carried out procedures on patients that weren’t required or charged us for providing treatment that would not have been given at all,” a source said.
In a rejig of packages offered under the scheme recently, the NHA had also reduced rates offered for 57 packages that were categorized as being prone to most abuse by hospitals.