Rajiv Gandhi Jeevandayee Aarogya Yojana Problems

This is an important update to the article I had written earlier on the Rajiv Gandhi Jeevandayee Aarogya Yojana scheme.

Dr. Thomas Kuruvilla shared his views in a comment on the earlier article.

I quote him verbatim,

You have to also see the flip side to this scheme. The RGJAY has been criticised by many because it is operation or procedure related, in that the hospital gets reimbursed by the Govt./Insurance only if the patient undergoes invasive procedures. Therefore, many private hospitals (especially those which are not doing well otherwise) use this scheme to bring in patients & conduct procedures or operations (sometimes when not indicated) so as to get reimbursed. It should be noted that the hospitals are not reimbursed for treating diseases with medicines. Therefore a medical line of treatment is not encouraged even when it may be as beneficial or even better than a surgical line of treatment. There have been several cases of unneeded removal of uteruses being done. One area where misuse is common is in cardiac ailments. These hospitals often advice patients to undergo angiographies/angioplasties/bypass surgeries even when a medical line of treatment is indicated. And the poor are easily fooled. So, please take a second opinion before undergoing these procedures when advised by hospitals empanelled under this scheme.

 

I was not aware of this angle. Thanks Dr. Kuruvilla for sharing this with everybody.

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Comments

  1. Dr. Thomas Kuruvilla says

    I do not want to sound like a pessimist. Hopefully, the Govt. will sort out these issues over time. At the same time it needs to be understood that there are many welfare schemes being undertaken by the Govt. Unfortunately, the implementation of these schemes are half hearted. It is better to ensure that existing schemes are implemented well rather than having more & more schemes which appear good on paper but are poorly implemented once the pomp & show are over. In the RGJAY itself, I’ve been told that in the case of angioplasties, stents of inferior quality are used. These stents have a rather high incidence of re-stenosis. Therefore, if such stents are used in patients who would have done well even without undergoing an angioplasty, we are probably causing more harm than good. Many private hospitals are not too concerned about the patients once the procedure or operation is done. It is imperative that these patients should be followed up to see the long term benefits. I do not think this is being done. It is easy to do an operation or procedure but what is important is whether these have long term beneficial effects. Will the surgeon or the cardiologist take the same care for a poor patient as he would take for an affording one? So, if there isn’t adequate monitoring & checks, there is every possibility that these schemes will be misused by private hospitals (and doctors working in them). Another criticism of the Health Scheme is that it concentrates on the top of the pyramid of diseases. It is well accepted that for public health schemes to benefit a significant percentage of the population one should concentrate on the lower layers of the pyramid where most diseases are concentrated. But I’m hoping that all these pitfalls will be overcome in the future. We just need a few honest men (and women) to see that these schemes serve the purpose for which they have been introduced.

  2. Felix D'costa says

    Even I too feel the same what Dr.Thomas have commented “In the RGJAY itself, I’ve been told that in the case of angioplasties, stents of inferior quality are used. These stents have a rather high incidence of re-stenosis. Therefore, if such stents are used in patients who would have done well even without undergoing an angioplasty, we are probably causing more harm than good. Many private hospitals are not too concerned about the patients once the procedure or operation is done. It is imperative that these patients should be followed up to see the long term benefits.” Personally my mom also been adviced to go for angioplasty wherein she has been diagonised with 2 blocks having 90% on LH and 60% on other side. Honestly we cannot afford for angioplasty as we would like to avail this facility but not able to understand what is right and whether it would be safe for my mom by undergoing with this scheme. My mom has done lot for me hence cannot risk her life. Request doctor Thomas for his help and support in this case. Thanks.

  3. Thomas Kuruvilla says

    Dear Felix, Sorry to hear about your mother. Hope she’s well now. It would be ideal if you could show your mother’s records to another cardiologist. I could help to an extent but would need more information. What is her age? Did she have a heart attack? How was she diagnosed to have a heart problem? Does she still have chest pain? What is her cardiac ejection fraction (from her 2-D Echo report)? Where exactly are the blocks in her arteries (this information can be obtained from her coronary angiography report)? Where do you reside (which part of Mumbai)? If you could send me these details I could try & help. Regards, Thomas

  4. Felix Dcosta says

    Thanks Doctor. Her Age- 77 yrs, Heart Attack – No, Chest pain – No, Block was diagonised when she underwent EPS due to SVT where angipraphy had to been done due to her age factor. 2-D Echo report: Concentric LVH, Normal Systolic function and diastolic function, LVEF – 65% , Angiography report – LAD: type 3 vessel. Focal mid segment 90-95% lesion. RCA: Dominant and has 60-70% lesion in mid RCA. Distally RCA is less than 1 mm in size. PDA – ver small less than 1 mm sized vessel, normal. PLV – from LCx and normal.

  5. Thomas Kuruvilla says

    Dear Felix, Your mother has good cardiac function. I will need some more information. Does she have diabetes, hypertension, raised cholesterol/triglyceride levels? What is the level of her LDL cholesterol? Is she physically active? Was this the first episode of SVT? At the time of the SVT did she have chest pain/breathlessness? Could you send me this information? Regards, Thomas

  6. Milind bhiwaji wasnik says

    Dear my father is undergone thruogh angioplssty as perdoctor he said that 1 block is 100% and three block are 30 % and know me to rajiv gandhi yojana
    comes under this

  7. pankaj gavhane says

    my friend have a problem with illness of kidney.
    He lost his both kidney are failed,he can’t understand how he treatment with his illness.
    He is from very poor family plese help us.

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