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Times of India
14 October 2011
By , Preetu Venugopalan Nair
Panaji, India

Only patients admitted in a general ward will be eligible for the government sponsored cashless health insurance for inpatient treatment for primary and secondary illnesses in government and private hospitals in Goa. If a patient is admitted in the ICU, the "Swarnajayanti Aarogya Bima Yojana" card will not serve to pay for treatment.

The card has a ceiling of Rs60,000. Admitting this, health minister Vishwajit Rane said, "The scheme is for primary and secondary illnesses and one doesn't need ICU admission for these illnesses." Doctors, however, differwith the health minister's view.

"Treatments under the scheme include major surgeries such as nephrectomy (surgery to remove part or entire kidney), abdomino perineal resection (removal of anus, rectum, or colon), commando operation (surgery for first degree malignancy of the tongue) and other such treatments, in which patients in a majority of cases need to be admitted in the ICU. Also what about patients who come to the hospital for primary and secondary care but later develop complications and need to be shifted to the ICU?" Association of Private Nursing Homes spokesperson Dr Govind Kamat said. Dr Mithun Mahatme of Mahatme Nursing Home, Bicholim said, "The intent may be good but implementation is not practical. The insurance is for admission in a general ward.

\What happens if an emergency patient comes and the general ward beds are full? Also, the rates quoted are low due to which we would be forced to cut corners which won't be in the patients' interest." Though private hospitals have shown discontent with the rates, ICICI Lombard, that will run the scheme, claims that Manipal, R G stone, Wockhardt and SMRC-Vivus hospitals (all corporate hospitals) have agreed to the terms and the company is in final talks with a several other hospitals as well.

Pvt hospitals roped in
FISG-ICICI Lombard GIC vice–president Birendra Mohanty said, "The implementation of the scheme has already begun and we have roped in more than 10 private hospitals in the network, along with three public hospitals. We are in negotiations with other private hospitals." Kamat, however, said, "The hospitals named by the insurance company are not members of our association. As far as we know, except for one member, none of the others have entered into an agreement with the insurance company. We have also called a meeting of all the members on Sunday to decide the future course of action." Goa has about 110 private nursing homes.

Rane added, "We want the association of private nursing homes on board. They do have some apprehensions but that will be resolved by ICICI." ICICI Lombard's "scope of services" clause states that the package will include "bed charges (general ward), nursing and boarding charges, surgeons, anesthetists, medical practitioner, consultants fees, anesthesia, blood, oxygen, OT charges, cost of surgical appliances, medicines and drugs, cost of prosthetic devices, implants, X–ray and diagnostic tests, food for patient etc". It also includes expenses incurred for diagnostic tests and medicines one day before admission and up to five days after discharge from the hospital.

Transportation expense from the patient's residence to the hospital is also covered and would be reimbursed in cash by the hospital to the patient on providing proof of expenditure. The maximum amount payable to the patient for transportation would be `100.

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