Delhi, Odisha yet to join PMJAY, their AIIMS seek clarity on treating patients under scheme

While 40-50 per cent patients in AIIMS Delhi are from outside the state, for AIIMS Bhubaneswar the figure is about 20 per cent. AIIMS Bhubaneswar has already sent a query to Union health ministry about logistics of the programme.

Odisha has also started its own Biju Swasthya Kalyan Yojana that will provide Rs 5 lakh annual health cover to 70 per cent of the state’s population.

Odisha AIIMS Director Dr Gitanjali said: “About 20 per cent of our patients are from neighbouring states. We had sent a query to the health ministry to know the logistics. We will certainly join the programme, but our situation is not unique. It is the same for AIIMS Delhi.”

Earlier this week, when Health Minister J P Nadda unveiled the PMJAY logo, he had said that all government hospitals would be “deemed to be empanelled”. The issue of non-participation of the state is a sticking point not just for AIIMS Delhi but also for other central government hospitals in Delhi, including Lady Hardinge Medical College, RML and Safdarjung.

According to Director Dr Randeep Guleria, AIIMS Delhi has already taken an “in-principle” decision to be a part of PMJAY. “About 40-50 per cent of our patients are from outside the state. We are going through the MoU. We will obviously sign it and continue to provide care to patients from outside the city and from within but there has to be some safeguards for our concerns.”

The institute has sought clarification from the government on reimbursements. For example, if a person from Maharashtra, which has agreed to join the scheme, is treated in AIIMS Delhi, will the payment come from the state or National Health Agency.

There are two other issues for AIIMS Delhi: the long waiting lists in some departments, and the fact that the institute does not do some procedures such as normal deliveries. “The MoU will have to build in these concerns. A PMJAY beneficiary who comes to the hospital will have to wait his turn along with other patients, he cannot jump the queue just because he is a PMJAY beneficiary. There are also other concerns — like we do not do normal deliveries, only complicated ones. That cannot change. We should be able to choose what procedures to do and what packages to offer under PMJAY,” Dr Guleria added.

For AIIMS and AIIMS-like institutes and other government hospitals, however, PMJAY has come as a financial blessing. All of them are heavily subsidised and staff salaries are paid by the government. So it is possible that they can make some profit from the PMJAY packages because according to the programme guidelines, hospitals that are able to complete procedures at lower cost can still keep the full package payment.