In a major relief for indigent patients covered under the state government’s cashless medical insurance scheme, it will empanel more hospitals and include additional medical therapies in its Mahatma Jyotiba Phule Jan Arogya Yojana (MPJAY). “We are drafting a new empanelment policy to improve access to quality and affordable healthcare through both schemes (MPJAY and Pradhan Mantri Jan Arogya Yojana) and to equitably distribute their benefits across the state,” said Dr Sudhakar Shinde, CEO, MPJAY. “There are are around 252 talukas in Maharashtra where not even a single hospital is empaneled. We will try to include most of these areas by covering the eligible hospitals there,” he added. At present, 492 hospitals across Maharashtra are empaneled under the MPJAY to conduct 974 therapies and surgeries with 121 follow-up packages in 30 identified specialties like general surgery, pediatric surgery and radiation oncology. This largely covers secondary and tertiary treatment.
The PMJAY or the Ayushman Bharat scheme has been launched in Maharashtra from September 23 and covers 83.72 lakh families identified under the Socio-Economic and Caste Census (SECC), 2011, for free medical treatment up to ₹5 lakh per family annually for 1350 medical packages and procedures. The state government is integrating the MPJAY and PMJAY, which will cover 90 percent of the population, and the PMJAY is being implemented in 79 government hospitals and medical colleges in addition to MPJAY empaneled healthcare institutions. Shinde noted that while areas like Western Maharashtra and cities like Pune and Kolhapur had a high number of hospitals under the MPJAY, a lesser number of these establishments were covered in Marathwada and Vidarbha. “There are few hospitals under MPJAY in backward and tribal districts like Nandurbar and Gadchiroli,” said Shinde, adding that the new policy would look at reducing the number of empaneled hospitals in areas where they were concentrated, with a corresponding rise in numbers elsewhere. Around 50 more hospitals will be added.
At present, the state government runs the scheme through the public sector National Insurance Company (NIC). “The new tender to be floated before December 2018 will include empanelment of more hospitals and new procedures,” said Shinde. Around 1000 patients are enrolled daily under the MPJAY for treatment and about 3.5 lakh procedures are conducted annually. So far, 19 lakh procedures have been completed. The state pays an annual premium of ₹1600 crore to the insurer. The annual insurance payouts amount to around ₹1540 crore. Launched as the Rajiv Gandhi Jeevandayee Arogya Yojana (RGJAY), the scheme was re-christened as MPJAY in 2017. In 2016, the state legislature’s estimates committee had red-flagged lacunae in the scheme including the use of cheap quality critical equipment like pacemakers, valves and stents, which adversely affect the health of patients and reuse of consumables. – DNA India