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Pul reviews APCMUHIS, proposes to make it patient friendly

Sentinel Digital DeskBy : Sentinel Digital Desk

  |  21 April 2016 12:00 AM GMT


ITAGAR, April 20: Aruchal Pradesh Chief Minister Kalikho Pul yesterday made a comprehensive review of the Aruchal Pradesh Chief Minister Universal Health Insurance Scheme (APCMUHIS) in its first ever governing body meeting since its inception.

The Governing body of APCMUHIS under the chairmanship of the Chief Minister, who also holds the health and family welfare portfolio, resolved to continue the Health Insurance Scheme in the State. The body while studying various loopholes in the scheme come out with measures to improvise the scheme and plan to make it more convenient and patient friendly, an official report informed here today.

The governing body resolved to form a committee with Commissioner Fince as the chairman to streamline the system. It was also decided to create a separate Project Magement Cell composed of health experts, who will constantly monitor the implementation of the scheme on fields. They would maintain the records and verify the facts by paying visits to the empanelled hospitals.

To improve health scerio in the State, Health Advisory Committee would be formed which would compose of retired doctors, health experts from outside and woman representatives as members. They will be the nomited members of the APCMUHIS Governing Body nomited by the Chief Minister, who is the chairman of the governing body, the report said. Pul asked the insurer to ensure that every poor family of the State are covered under the Health Insurance scheme and not to leave even a single household uncovered (except those in the excluded list). He advocated for the billing to be done as per the actual cost of treatment instead of package wise. As it was observed during the case studies that though the patients were treated for minor ailments for a day in the hospital, the hospitals swap the bill for the whole package.

The Chief Minister made case studies on the basis of prescriptions reports made by the doctors and bills submitted and found huge differences in the amount charged by the hospital through APCMUHIS and the actual cost of treatment.

In one such case in a local hospital of the State, it was found that one acute pancreatitis patient was charged and swapped Rs 75,000 from his APCMUHIS account for diagnosis and treatment whereas the actual cost of diagnosis treatment comes to Rs 24,400 only as worked out by the doctors as per the prevailing rates in the State. Pul said, “This is just one example and wonder how many similar cases will be there in the State? This is an injustice to the patients and depriving them from the benefits that should actually be accrued through this scheme.” He said that due to misunderstanding between the Insurer and the empanelled hospital in accounting, patients are suffering. He asked them to get it corrected and maintain proper accounting procedure.

He asked the Insurance Company to establish office in the State capital in order to carry out timely scrutiny of the documents instead of sending them to the Head office at Mumbai which is time consuming and incurred unnecessary expenses. He further told them to make spot verification, visit the hospitals and also to enquire from the patients.

The Chief Minister also released Rs 2.17 Crore to the New India Assurance Company to clear the pending bills against the empanelled hospitals under APCMUHIS.

He also assured that the remaining balance amount would be released to them and asked the Insurer to immediately clear the pending bills against the empanelled hospitals including that of Pasighat General Hospital and Aditya Diagnostic Centre, Dibrugarh, the report added.

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