Srinagar:

The government has removed four surgeries from the list for private hospitals and restricted them to government-run healthcare facilities only from Saturday (March 15). The procedures include cholecystectomy (removal of the gallbladder), haemorrhoidectomy (haemorrhoid), sphincterotomy (fissure in ano), and appendectomy (appendix).

The Jammu and Kashmir government has barred private hospitals in the region from offering key surgical procedures under the free health insurance scheme, the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY), per an official order.

This is among other significant changes brought by the J&K State Health Agency (SHA) to health benefit packages across the region, which would probably impact the fledgling private hospitals in the Union Territory.

“In pursuance of the decisions taken in the 8th & 9th Governing Council meeting of the State Health Agency, it has been decided to implement significant changes in the Health Benefits Packages (HBP) 2.2 across all empanelled public and private hospitals in the UT of J&K,” reads the official order.

The AB-PMJAY, or the ‘Golden Card’ scheme, offers cashless health cover of Rs 5 lakh per annum to over 86 lakh beneficiaries in the J&K. Until now, the four surgical procedures formed the bulk of the total surgeries carried out in private hospitals under the scheme in the region.

According to private hospitals' data, 114,000 surgeries were performed in these health institutions, with 65 per cent comprising surgeries like gallbladder, haemorrhoid and appendicitis.

Additionally, the price package for private hospitals has also been revised with a 10 per cent additional price to them discontinued now onwards.

Over 250 hospitals are empanelled for the scheme to offer medical and surgical treatment to beneficiaries. But many private hospitals have faced action, with the central government uncovering Rs 11.8 crore in frauds committed by them by presenting fake and fraudulent bills under the scheme.

On the other hand, the removal of the four procedures is expected to increase the waiting time for patients in government facilities. But many doctors at government facilities hailed the move, arguing that the scheme was being “misused” for financial gain.

A senior doctor at Government Medical College and Associated Hospital in Srinagar conceded that patient footfall to hospitals might temporarily rise but believes it will stabilise over time.

He pointed to the strengthening of peripheral health facilities, which are now equipped to handle these surgical procedures.

“These basic surgeries were largely being performed in private hospitals under the scheme, which affected postgraduate medical students,” he added. “With this change, we can improve clinical training while curbing misuse of the scheme.”

Another doctor who would perform procedures at private hospitals under the scheme, however, said the scheme was “misused” by only 10 per cent while it would largely benefit people irrespective of economic status to get treated at their place of choice.

A spokesperson for the private hospitals, however, said that excluding the four procedures undermines their ability to provide quality care to patients.

“Despite our commitment to serving the community, the reduced rates make it unsustainable for us to continue operations,” the statement said while threatening to lay off staff.

It claimed to offer jobs to about 10,000 people, and the new decision ‘will force them to relieve the employees and hence increase unemployment.’

The statement added that Rs 350 crore is pending with the government despite assurance by the J&K Chief Secretary of clearing their dues by December last year.

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