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Hysterectomy tops Ayushman claims; red flags raised

The NHA is the implementing body for PM-JAY and had commissioned a working paper titled ‘Patterns of utilisation for hysterectomy: An analysis of early trends from Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (PMJAY)’ in May this year.

, ET Bureau|
Jul 22, 2019, 08.39 AM IST
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The report has also asked for a closer scrutiny of claims in Haryana, Jharkhand and Arunachal Pradesh due to discrepancy found in the data submitted.
New Delhi:A study commissioned by the National Health Authority (NHA) has red-flagged claims made for hysterectomies conducted in private hospitals in at least six states under the Pradhan Mantri Jan Arogya Yojana (PMJAY). It has sought more caution and tighter scrutiny of such claims under the Modi government’s flagship programme that promises universal healthcare to nearly 10 crore beneficiaries.

The NHA is the implementing body for PM-JAY and had commissioned a working paper titled ‘Patterns of utilisation for hysterectomy: An analysis of early trends from Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (PMJAY)’ in May this year.

A government official associated with the project told ET that the paper was part of a regular analysis of the trends and data within the health scheme to ensure checks and balances in its implementation. “Hysterectomies have traditionally been a source of misuse by the private sector for insurance claims. Wrongfully done procedures have a bearing on the overall health of women as we saw in recent news reports. This is a public health issue,” a government official at Ayushman Bharat told ET when contacted.

As per the report’s findings submitted earlier this month, hysterectomy comprised 2% of the claims submitted for women and 1% of all claims submitted across 24 states and union territories so far. Six states –– Chhattisgarh (21.2%); Uttar Pradesh (18.9%); Jharkhand (12.2%); Gujarat (10.8%); Maharashtra (9.0%); and Karnataka (6.6 %) –– which made the highest number of claims under PM-JAY, also generated nearly 75% of all hysterectomy claims.

States like Chhattisgarh and Uttar Pradesh have a large number of claims made from the private sector. While claims from Uttar Pradesh were nearly 5% of all medical claims under the Ayushman Bharat scheme, it generated 18.9% of all hysterectomy claims.

In Chhattisgarh, 94.5% of all hysterectomy claims in the state were made from private hospitals which raises concerns.

The report has also asked for a closer scrutiny of claims in Haryana, Jharkhand and Arunachal Pradesh due to discrepancy found in the data submitted.

An expert associated with the report, told ET that as per the findings of the latest National Family Health survey (2015-16), the percentage of hysterectomies conducted on women between the ages 15-49 was 7%. The percentage of hysterectomy claims made by PMJAY was lower at 2% so far, but there was still a need to “keep an eye” on these figures.

“There is a tradition of hysterectomies being conducted for family planning procedures in several states. Women would often have their uteruses removed to be able to work in the fields and earn their wages, unhindered by menstruation. Hysterectomies conducted before the age of 40 can cause early menopause in younger women that affect their health early,” the expert said.
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