Private hospitals threaten to quit PM JAY-Ayushman Bharat Scheme en masse
Ludhiana: Alleging that health insurance firm was harassing the private hospitals on "flimsy" grounds, over 300 doctors across Punjab, who have their hospitals empanelled under the Pradhan Mantri Jan Arogya Yojana-Ayushman Bharat Scheme, along with Punjab chapter of the Indian Medical Association (IMA) branch officials have threatened to exit the scheme en masse.
In an emergency meeting of the Indian Medical Association (IMA), Punjab chapter, the members of the Association have threatened to pull out of the central government scheme of Pradhan Mantri Jan Arogya Yojna (PM-JAY, Ayushman Bharat), alleging delay in settling claims and rejection of the claims by the associated insurance company.
Around more than 300 doctors coming from various parts of Punjab attended the meeting which was held in Ludhiana on Sunday.
The private hospitals threatened 'mass quitting' the scheme accusing the state government and SBI General Insurance Company of exclusively reserving 194 treatments for government hospitals. They accused them of depriving the public of quality health services.
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Holding the insurance company and state government responsible for the failure of the scheme in Punjab, Dr Vikas Chhabra, Indian Medical Association's (IMA) Bathinda unit president said, "Annoyed with problems being faced by empanelled hospitals, an emergency meeting of the IMA-Punjab was called on October 10. More than 300 doctors from all over Punjab, who have their hospitals empanelled under the scheme, along with IMA branch officials, attended it and submitted an authority letter for quitting the scheme en masse."
The members alleged harassment of private medical facilities by SBI General Insurance via various methods like delaying claim settlements, conducting inspections by BAMS/BDS/BHMS and then issuing show-cause notices, deducting or rejecting claims on "flimsy" grounds.
They alleged that when the insurance company intentionally delays the authorization of cases, patients are left with no choice but to wait for two to three days to begin the treatment. This results in wastage of resources and manpower delayed claim settlements and unnecessary queries.
"The doctors agreed that in the rat race to grab the tender, by all means, insurance companies filed proposals at such a low quotation that later, they had to manipulate things to sustain", added Dr Vikas
Demanding the government to maintain transparency in the scheme, Association's honorary secretary Dr Ashish Ohri stated that if the government wants certain treatment to be exclusively reserved for government hospitals, then accordingly information should be shared with the public too, adding, "People accuse private hospitals of not giving benefits to them under the scheme. The government should not reserve any package/treatment so that everyone can have access to medical facilities at private hospitals"
As per a recent media report in The Tribune, Dr Vikas alleged that the previous insurance company had decreased claims by getting 194 treatment modalities reserved exclusively for government hospitals, further adding that the present company was also functioning in a similar manner by pressing upon the government to further reserve few more packages only for government hospitals.
Further Hindustan Times reports, meetings were held by the Patron and former Punjab IMA president Dr Manoj Sobti with the state government and former health minister Balbir Singh Sidhu in the past on the same issue, but no conclusive changes took place. Dr. Ohri further said, "A delegation of IMA members is expected to have a meeting with deputy chief minister OP Soni on Tuesday and if the government fails to resolve the issues, we will be left with no other option but to go for quit the scheme en masse"
The Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB PM-JAY) is a national public health insurance scheme of the government of India, launched in 2018 by the Ministry of Health and Family Welfare stating to provide free access to healthcare insurance coverage for low-income earners in India, providing free secondary health care and free tertiary healthcare for those requiring it.
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