SURAJ NANDREKAR
PANJIM: The Universal Health Insurance Scheme – Deendayal Swasthya Seva Yojana – of the State government seems to defy all logic. Herald has already revealed that the scheme is of no benefit to the common man. There is now another shocker – treatment in private wards of the Goa Medical College (GMC) is not covered under the scheme.
Shocking? The scheme document, copy of which is in possession of Herald, plainly states, “This scheme does not cover private wards in GMC.”
A medical expert, speaking to Herald on condition of anonymity, wondered how the government will convince private hospitals to partner in the scheme when they are not ready to give the scheme benefits in their own private wards.
“The general wards in some hospitals are much better than the GMC private wards. How do you expect private hospitals to be a part of the scheme when you yourself do not agree with the rates for the GMC private wards?” he asked.
Further, he said, the scheme does not have clarity on whether treatment in private wards is allowed or not in private hospitals. “The scheme is raw and vague and seems to be senseless, finalised without applying the mind,” the expert said.
Nothing for common man
As you go through the documents there are further revelations that there seems to be nothing for the common man in the scheme.
There is no clarity on how the government or the common man would benefit as out of 447 interventions listed by the government, 280 will have to be carried out only at the GMC. So how does the scheme benefit Goans? People were being treated at GMC for free so there is nothing new in the scheme.
Prima facie it seems that the scheme is only beneficial to government-run hospitals such as GMC, Hospicio, Asilo and Ponda ID hospital as they were treating patients for free earlier but would now get paid by the insurance company for treatments carried out.
Experts state that private hospitals are unlikely to get empanelled in the scheme as the rates offered by the government are below par and unviable.
“Ninety percent of the interventions listed would be carried out only in the GMC. Of the remaining 10 percent, you hardly find any patients for these ailments in Goa. Maybe there would be 300 overall patients per year,” said an expert in the field.
He added that the rates offered are ridiculous as a CT scan has to be done at Rs 500 whereas it costs no less than Rs 2000 in any hospital. Similarly, a MRI scan is offered at 900, which otherwise costs around Rs 4000 to Rs 5000.
“The question arises is whether the government wants to under treat patients,” said another expert. He suggested that the government open up all interventions to private hospitals so that they can participate. “Otherwise the interventions offered to the private hospitals are rare and can be carried out by only few hospitals in Goa,” he said.
The document states that the rates are as notified by some renowned hospitals from time to time like AIIMS, NEIGRIHMS Shillong, NIMHANS 6.PGIMER Chandigarh, Tata Memorial Hospitals, JIPMER Puducherry and CMC Vellore.
However, experts differ on this saying, “The amount of medication for chronic lifestyle and debilitating disorders, ie diabetes, hypertension, epilepsy, glaucoma and multiple sclerosis shall not exceed Rs 15000 per year with quarterly authorization from government doctors for continuation of treatment.”
“How can you put a slab on the treatment of diabetes, which is most common in Goa? The scheme needs to be re-worked taking into consideration all stakeholders,” an expert said.
