On Tuesday, Siddhant Hazare (17) lay on a hospital cot, eagerly awaiting Wednesday when his long-awaited surgery would take place at KEM Hospital after which he would be able to resume school. The Nashik resident is among the beneficiaries in Maharashtra of Ayushman Bharat, who have or will undergo the newly introduced cashless hip and knee replacement procedure.
On January 13, the government will observe 100 days of Ayushman Bharat. Since its launch on September 23, 11 patients have undergone hip and knee replacement procedures in the state. The surgeries have taken place in Jalgaon, Pune, Chandrapur, Nagpur, Latur and Yavatmal. The state has spent Rs 60,000 to Rs 1.2 lakh on each procedure.
On Wednesday, Mumbai will join the league of cities conducting hip and knee replacement surgery under the cashless health insurance scheme.
Siddhant, a sickle cell disease patient, was advised a hip replacement procedure after he suffered an accidental fall. “I could not go to school for six months. I stopped playing,” he says. From Satpur village, his parents took him to Nashik Civil hospital, where they stayed for three months before being referred to Mumbai two months ago.
The 17-year-old was eligible under Ayushman Bharat’s Pradhan Mantri Jan Arogya Yojana (PMJAY) and a golden record was created for Siddhant under the cashless health insurance scheme, said Dr Abhimanyu Kotwal, Mumbai coordinator for the PMJAY scheme. “We had already spent over Rs 50,000. There was no money left for his surgery,” mother Girija said.
Sickle cell disease is a blood disorder that requires frequent blood transfusion and may require a joint surgery if clotting takes place. Siddhant’s father, a driver, earns Rs 7,000-8,000 per month. The surgery costs between Rs 75,000 and Rs 1.5 lakh. Siddhant has already undergone blood transfusion three times. “We are hopeful he’ll go back to school once the surgery is successful,” Girija says.
The PMJAY has 1,300 procedures listed for the socio-economic caste census beneficiary population. Officials said demand for the newly introduced hip and knee replacement procedure will surge in coming weeks and a conditional access will be provided to avoid unwanted surgeries. “We are only allowing the procedure for osteoarthritis condition in grade III and grade IV. If we become liberal in approving all hip and knee surgeries, we fear doctors will opt for surgery instead of conservative treatment,” said Dr Sudhakar Shinde, CEO of the health insurance scheme in Maharashtra.
While the cost of these procedures is high, the surgery can also have mobility and morbidity impact on young patients. The Maharashtra government has decided to keep both procedures out of private hospitals’ ambit to ensure undue procedures are not conducted to cash in under the insurance scheme.
With current tenders for state health insurance scheme set to end in January, the Maharashtra government is set to enroll private hospitals in Ayushman Bharat. At least 1,100 hospitals have been wait-listed.