PM-JAY: J&K Govt Holds Payments Of Empanelled Hospitals, Patients Suffer

Srinagar- When Doctors told Waseem Adil that the gall bladder of his wife needs to be removed immediately by Laparoscopic surgery, he thought that the Golden Card would come to rescue as he was running short of money.

Adil, who lives in South Kashmir’s Shopian immediately, rushed his wife to Shifa Hospital in Srinagar. On reaching there, he was told that they can’t cover this surgery under the Golden Card scheme.

“I was told that the scheme is valid for only two diseases,” Adil told Kashmir Observer.

The “financially poor” man then rushed his wife to Modern Hospital in Srinagar where he was told the same story and was asked to pay Rs 40000 to conduct the surgery.

“I was helpless. I couldn't see the conditions of my wife,” he said.

In order to save the life of his wife, Adil then started collecting money from his relatives and friends.

“I collected the money in the shortest possible time and submitted it before the receptionist.” Adil said.

A discharge certificate from the hospital, a copy of which lies with Kashmir Observer, shows that Adil’s wife Asiya with MRD number MJ-159-03-2022 was operated on March 16, 2020.

Like Adil there are thousands of patients who were turned back from the private hospitals by the administration on the pretext of 'delay in payment by Government’ or that they don’t cover all the surgeries under the Golden Card scheme.

One hundred sixty five Government and private hospitals in J&K have been empanelled under the scheme.

PMJAY or Pradhan Mantri Jan Arogya Yojana is a flagship health insurance scheme by the Government of India. Also known as Ayushman Bharat Yojana, it provides financial security to the beneficiaries against hospitalization expenses in case of a medical emergency. It has been designed to cover the poor, vulnerable and the economically weaker sections of the society.

It was launched in September 2015 by Prime Minister Narendra Modi. This scheme provides a cover of Rs 500,000 per family per year for secondary and tertiary care hospitalisation.

In J&K, the Golden Card issued under SEHAT Scheme of the Government enables all residents including employees and pensioners as well as their families to avail cashless quality health care services across public and private empanelled hospitals.

There is no restriction on the family size, age or gender. All pre-existing conditions are covered from day one.

However, all is not well with this scheme in the newly carved Union Territory (UT) as the poor patients are often turned away from private hospitals.

Reports said that top private hospitals in Srinagar, including Shifa Hospital, Florence Hospital, Khyber Institute and many other hospitals don’t cover all the surgeries under this scheme.

“Only few are covered under this scheme. Also the government hasn’t empanelled many surgeries under this scheme,” sources from the Health department told Kashmir Observer.

“We want to know whether this card is valid anywhere or it is simply a deception to people of Kashmir,” Adil laments.

The list of hospitals empanelled to provide cashless treatment to patients with Golden Card on the other side claim that the Government has not cleared their payments since the last three months.

According to a report, the financial liabilities of the scheme have mounted to Rs 70 crore which prompted the private hospitals and nursing homes to refuse dispensing services.

According to the directives from the Union Health Ministry the amount needs to be cleared to the concerned hospitals within 15 days.

“We conducted general surgeries, cardiology surgery, oncology and urology surgery under this scheme. We have been empanelled by the government for only four surgeries,” an official from Golden card department from Florence Hospital, Chanapora told Kashmir Observer.

He said the Government has not cleared the payment of around Rs 2-3 crore under this scheme from the last three months.

“We have covered at least 600 patents from the last three months under this scheme, however the payments have not been cleared by the government yet,” he added.

An official from Shifa Hospital told Kashmir Observer that they also haven’t received the payment from the insurance company from 26 December 2021 till date and are still looking after the patients under this scheme on humanitarian grounds.

“Even today we admitted six patients under this scheme but the government doesn't understand,” he said.

As per MoU, the Insurance company Bajaz Alianz has to pay the claim amount to the hospitals however the Insurance company has failed to do so as of now.

“We haven’t received the amount from the Health Department for many months. How will we pay,” an official from the Insurance company said.

According to the reports, the agreement with the Bajaz Alianz expired on March 15, 2021 and now the MoU has been signed with the new Insurance Company- IFFCO Tokyo for the next year.

Mohammad Yaseen Choudhary, Mission Director, National Health Mission told Kashmir Observer that the Rs 68 Crore liability crisis will be cleared in a phased manner and the first installment has been cleared on Last week on April 22.

Choudhary, who holds the additional charge as CEO of Ayushman Bharat Pradhan Mantri Jan Arogya Yojna said it is the hospital's choice as to which specialties they want to empanel.

"They aren't bound by rule to empanel all specialties," he added.

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Auqib Javeed

Auqib Javeed is special correspondent with Kashmir Observer and tweets @AuqibJaveed

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