District panel recommends de-empanelment of six hospitals from govt health insurance scheme

The Pune district administration has pulled up six hospitals for poor implementation of the Mahatma Jyotiba Phule Jan Arogya Yojana (MJPJAY), the flagship health insurance scheme of the state government. At a meeting on Tuesday, the district monitoring and grievance redressal committee decided to recommend the de-empanelment of six hospitals from the scheme.

The scheme provides end-to-end cashless services for identified diseases through a network of service providers from both the government and private sector. District Collector Dr Rajesh Deshmukh told The Indian Express that the administration has received 86 complaints and various grievances were being redressed.

Civil surgeon and member-secretary of the redressal committee, Dr Ashok Nandapurkar, said notices have been issued to the six hospitals. “Despite repeated reminders, the scheme has not been fully implemented,” said Dr Nandapurkar.

The committee will give the names of these hospitals to the state Health Society, to de-empanel then from the scheme. Launched as the Rajiv Gandhi Jeevandayee Arogya Yojana, the scheme was renamed MJPJAY in 2017. The scheme offers insurance of Rs 1.5 lakh per family per year, and has various packages ranging from Rs 20,000 to Rs 80,000. Beneficiaries under this scheme are families holding yellow ration cards, Antyoadaya Anna Yojana card, Annapurna card and orange ration card.

In Pune district, a total of 78 hospitals — 62 private and 16 government — are empanelled under the scheme. Eighteen of these empanelled hospitals are in PMC areas, four of them government-run hospitals, while there are eight such hospitals in PCMC areas, two of them run by the government. Pune rural has 47 empanelled hospitals, of which eight are government hospitals.

A total of 11,669 Covid-19 patients have benefitted under the scheme in the last eight months. According to district health authorities, among the 86 complaints recived by them, a majority pertain to hospitals taking money for treatment despite being covered under the scheme, and even cases of Covid-19 patients being denied treatment.

“In such cases, if we find that the hospital is at fault, then the management is asked to return the money to the patient,” said Dr Nandapurkar. “We are also involving members from the Indian Medical Association to ensure a wider reach of the scheme,” he added. Till now, 19 complaints have been resolved, said officials.

Source: The Indian Express