* Matter taken up with NHA for way out: SHA
Irfan Tramboo
Srinagar, Dec 22: The patients at Shri Maharaja Hari Singh Hospital (SMHS) here are facing a tough time as the hospital authorities have stopped the AB-PMJAY-SEHAT benefits for patients requiring thrombolysis.
The situation becomes alarming when patients-who have suffered a cardiac arrest reach the emergency section of the hospital-are informed that the said procedure, which requires the thrombolytic agent costing nearly Rs 20,000, cannot be covered under the Health Insurance Scheme.
Those privy to the matter told Excelsior that the issue is related to the patients’ stay at the hospital, which is creating the issue, noting that those with a stay of more than 24 hours are receiving benefits according to the guidelines, and their cases are sent for the claim process.
“However, for those with a stay of less than 12 hours at the hospitals, those cases do not comply with the guidelines and, therefore, do not receive the necessary benefits,” they said.
The issue faced by the officials of SMHS is that patients are brought to the emergency hospital where they undergo the necessary procedure. However, a fully functional Cardiology Department is present at the Super Speciality Hospital, Shireen Bagh, which then takes over the rest of the treatment.
After the procedure, some patients are required to be sent for further treatment at SSH, which houses the Cardiology Department. There, they are registered again, ending the stay at the SMHS, leading to a disruption in the entire process of benefit claims, affecting people in the end.
While these cases could have been handled at SSH without facing the issues of patient stay, it is to be noted here that the hospital does not have an operating emergency section, leaving SMHS as the only option available for people, where from the selected cases are shifted further.
Pertinent to mention here that the patients who have to undergo the thrombolysis require a drug named Reteplase, which is ideally covered under a dedicated package of the AB-PMJAY-SEHAT and benefitting such patients immensely in other hospitals across J&K.
Further, while there are no clear-cut directions from the SHA regarding halting the service to such patients as such, the hospital has arbitrarily made a decision to halt the benefits of the AB-PMJAY-SEHAT to patients requiring thrombolysis to evade potential audit objections later.
‘Excelsior’ has also learned that the issue has been raised time and again with the concerned authorities, especially, SHA, apart from being discussed during a review meeting, but to no avail. However, amidst all this, the patients are facing a tough time.
Medical Superintendent, SMHS Hospital, Dr. Muzaffar Zargar, told ‘Excelsior’ that cases with a stay of 24 hours at the hospital are receiving benefits, “but cases with a stay of less than 12 hours, and are shifted to SSH for further treatment in the Cardiology Department, are facing issues,” he said.
The officials of the SHA told Excelsior that they have taken note of the matter and have raised the same with the NHA to find a way out.
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