DENYING a study by the Tata Institute of Social Sciences (TISS), which said that 63 per cent beneficiaries of the state government’s Rajiv Gandhi Jeevandayee Arogya Yojana (RGJAY) incurred out-of-pocket (OOP) payments for services when admitted to the hospital, Rajiv Gandhi Jeevandayee Arogya Yojana (RGJAY) Society have said that about 6.62 lakh surgeries were performed under the scheme in Maharashtra, of which 6,232 grievances were raised, amounting to 0.94 per cent of the total and 82.22 per cent grievances were resolved till November 15.
An official from the RGJAY Society said that in case of repetitive complaints on out-of-pocket expenditure, showcause notices have been issued to the hospitals. The official said that till date, on the basis of various kinds of complaints received from the patients, empanelment of 102 hospitals has been cancelled and seven hospitals have been suspended from the scheme. The TISS report had further said a significantly higher proportion of persons from Below Poverty Line (BPL) families (88.23 per cent) reported paying for diagnostics, medications, or consumables, and that almost half of the beneficiaries were actually from the non-eligible category.
Under RGJAY, launched by the Maharashtra Government in 2012, both BPL and Marginally Above Poverty Line (MAPL) families, with annual income upto Rs 100,000, are entitled to receive free medical treatment in empaneled hospitals for identified critical 971 surgeries or therapies. “During the initial first year, from July 2, 2012 till July 1, 2013, 2,600 grievances were raised, of which 884 (34 per cent) were for diagnostics, treatment, and for out-of-pocket expenses. 89 per cent of the total grievances received were resolved. In case of grievance regarding any kind of demand from empaneled hospitals, the Society takes strict action against these hospitals. Till the time grievances are not settled, the claims of the respective hospitals are put on hold. In case of repetitive complaints of out-of-pocket expenses, showcause notice is issued to the hospital. In those hospitals, where malpractices did not stop, they were suspended or de-empaneled from the scheme,” said an official from the RGJAY Society. According to available figures, till November 15, 1,108 grievances (17.78 per cent) were yet to be settled. Till date, 6,61,333 procedures or surgeries have been performed, amounting to Rs 1641.10 crore, of which 24 per cent of the total procedures were performed at government hospitals, while 76 per cent were in private hospitals.