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Health Insurance For People, Not Hospitals

Even before the Deen Dayal Swasthya Seva Yojana offering health insurance cover to all Goans could be formally made operational, private hospitals, would-be partners of the scheme, want the government to modify the scheme to allow them to perform all the 447 medical or surgical procedures identified under the scheme and also increase their rates. The government has allowed 171 procedures for private hospitals as of now. The private hospitals are obviously pitching for a bigger share of the insurance cake, swollen in their presumption that an effective implementation of the scheme is not possible without them. The government’s position is that the private hospitals first perform well. Private hospitals must treat patients in a transparent manner to remove doubts about unnecessary procedures. Though the government has set aside 171 procedures for the private hospitals, including life saving, organ saving, radiation and chemotherapy, neo-natal ICU, kidney and liver failure, these procedures actually add up to nearly 500 if all the sub-divisions of the 171 procedures are taken into account. Why are the private hospitals making such a great fuss then? Is not the government right in saying that the scheme is for the benefit of the people not for the benefit of private hospitals? Feelings are growing among the general public that private hospitals have exposed their greedy teeth even before the launch of the scheme by demanding rate hike and more procedures. Private hospitals already have an unenviable reputation for charging patients highly. Public vigilance and government supervision has to guarantee that the private hospitals do not usurp the funds by manipulating the treatment line and then drive the patients to government hospitals for further treatment.

The government and private hospitals have to work hand in hand to ensure the benefit of the scheme goes to the people in need of treatment at the right time. They have to draw up a plan with line of treatment for each of the procedures that would be involved in treatment of the patients before the scheme is launched. Since the scheme is being launched for the benefit of the society the doctors in the private sector should contribute their might for the healthcare of the Goans. They could use the government scheme for the purpose but keep the interest of the patients as paramount. The scheme should be seen as a blessing in disguise by the private hospitals as many people who otherwise would have preferred treatment in government hospitals in the absence of the health insurance scheme would now seek to avail treatment at the nearest private sector hospitals or clinics. The procedures allowed for the private sector are the ones which are mostly not being done in the government sector and the private sector hospitals would have virtual monopoly over them and derive maximum benefit from them. To ensure that the scheme is run without hassles and prevent manipulations the government has to clearly demarcate the role for the government and private hospitals.

Even though there is likely to be much pressure to tweak the scheme in favour of the private hospitals from vested lobbies, the government should not succumb to the pressure tactics and ensure that the general public gets the best out of the first-of-its-kind scheme in the country. It should uphold the rights of the Goa Medical College to conduct all the 447 procedures identified by it and ensure that it get continuous flow of patients of all ailments so that students studying at the GMC get to learn to conduct procedures. Besides, the government must see to it that the scheme remains public-centric and is not allowed to be hijacked by vested lobbies for their gain. Any relaxation on the issue could have detrimental impact on the future of the only medical college in the state as the students could lose opportunity to deal with complex cases in the absence of patients if they are taken away by private hospitals. It is the responsibility of the government to see to it that the flow of patients to the GMC continues and private hospitals do not cut into the flow. Besides, doctors in private hospitals, many of whom are products of the GMC, should desist from taking away patients from GMC for their personal benefit and allow their alma mater to grow in all spheres of medical education. This would guarantee that doctors passing out of GMC do not have knowledge limited to only certain ailments in absence of patients but have capacity to deal with all types of patients.

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