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Ayushman Bharat Arogya Karnataka: Health Dept. considering relaxing referral system for certain procedures
Ayushman Bharat Arogya Karnataka: Health Dept. considering relaxing referral system for certain procedures

The Hindu

time5 days ago

  • Health
  • The Hindu

Ayushman Bharat Arogya Karnataka: Health Dept. considering relaxing referral system for certain procedures

Realising that the existing online referral system (ORS) has significantly complicated service delivery under the Ayushman Bharat Arogya Karnataka (AB-ArK) scheme, the State Health Department is examining a proposal to relax referral requirements for certain super-speciality procedures in the first phase. Apart from this, the department is also considering doing away with referrals for all simple secondary procedures in BBMP areas. This is because the existing government hospital beds in Bengaluru are not proportionate to the population and the referral system is causing severe hardship to needy patients. The proposal has been drafted following a detailed review of the existing online referral system through field visits and interactions with various stakeholders, including health service providers, beneficiaries at private medical colleges and empanelled private hospitals, as well as field staff from the Suvarna Arogya Suraksha Trust (SAST), the agency implementing the health scheme. The (AB-ArK) scheme covers 1,650 procedures — 294 simple secondary, 251 complex secondary, 934 tertiary care procedures and 171 emergency procedures. While the simple secondary procedures are completely handled at the government hospital level, for all other procedures, patients need to be referred by a government hospital to a higher facility (including empanelled private hospitals) if the former is not equipped to treat the illness. The scheme offers cashless treatment up to ₹5 lakh a year per family. Around 3.42 lakh patients have been referred online since June 2022, when the ORS was introduced in Karnataka, till June 2025. The referral policy, which has been in place since the inception of the scheme and was done manually prior to June 2022, has undergone multiple changes. Initially, the scheme offered free services at government institutions and package based services at the private hospital. However, it was later modified to include reimbursement packages for government hospitals for various procedures — 50% (secondary), 75% (tertiary), and 100% (cardiac) of the total package cost. Government institutions currently receive approximately ₹1,000 crore annually from the scheme in the form of claim reimbursements. Issues with referral system Harsh Gupta, principal secretary (Health and Family Welfare), told The Hindu that interactions with various stakeholders had revealed that the existing referral system has significantly complicated service delivery under the scheme, particularly for under-privileged sections of society. 'It adds another layer of complexity during emergencies. Patients are forced to navigate the process just to access services at empanelled institutions,' he said. 'The proposal is to relax the referral requirements for certain procedures that would anyways have been referred by a government hospital to a private empanelled facility. Procedures such as cardiology, cardiothoracic surgery, cardiovascular surgery, urology, medical oncology, surgical oncology, and radiation oncology can be considered in the first phase. The applicability of the referral policy should depend on the accessibility, availability of services, and capacity of the healthcare system, as well as the patient load,' he said. In reputed medical college hospitals Besides, referral relaxation is also under consideration for neonatal codes related to babies born in non-empanelled hospitals. This is likely to be permitted exclusively for medical colleges with adequate infrastructure. 'On a pilot basis, we have relaxed referral requirements for a sub-set of complex secondary and tertiary procedures at Sathya Sai Memorial Hospital in Chikkaballapur district and BLDE Medical College Hospital in Vijayapura for the last six months. Now, we want to try it out in other reputed medical colleges, selected on some objective criteria such as those preferred by top rankers in NEET exam. We can list out top 50% of such colleges either on this criteria or on some other reasonable criteria. Thereafter, these selected private medical colleges can be exempted from the requirement of reference for tertiary procedures,' he explained.

Cabinet clears health insurance for three lakh contract, outsourced employees
Cabinet clears health insurance for three lakh contract, outsourced employees

The Hindu

time19-06-2025

  • Health
  • The Hindu

Cabinet clears health insurance for three lakh contract, outsourced employees

The State Cabinet on Thursday decided to bring three lakh outsourced and contract employees/workers in various departments and their dependents under the Suvarna Arogya Suraksha Trust for providing cashless health insurance of up to ₹5 lakh a year. The employees have to contribute ₹100 a year as health insurance premium while the government bears the rest of the cost, according to Law and Parliamentary Affairs Minister H.K. Patil. Suvarna Arogya Suraksha Trust was established in 2009 for providing cashless health insurance. Mobile health clinics The Cabinet approved a ₹17.97-crore proposal for providing mobile health clinics in remote areas of the State. The clinics would enable residents of isolated or remote areas to access primary healthcare services. A proposal to declare Mugli-Apsarakonda Marine Sanctuary as Karnataka's first marine sanctuary was also cleared. The sanctuary is spread over 5,959 hectares, near Honnavar in Uttara Kannada district. The proposal was approved by the Karnataka State Board for Wildlife a few years ago. The Cabinet cleared the revised expenditure of ₹742 crore for the Anubhava Mantapa at Basavakalyan in Bidar district. Earlier, the project cost was ₹612 crore and the hike in GST from 12% to 18% on materials is said to be the reason for the cost escalation. Processing unit A ₹35.07-crore proposal of the Horticulture Department to set up a processing unit for mango and other horticultural crops on a PPP model on 28.3 acres at Yalavatti village in Hangal taluk of Haveri district was cleared by the Cabinet. A proposal to rename the Basapura village in Hangal taluk of Haveri district was approved, and the village was renamed as Gerugudda Basapura, Mr. Patil added.

Karnataka reconstitutes expert panels to revise healthcare package rates, private hospital norms
Karnataka reconstitutes expert panels to revise healthcare package rates, private hospital norms

New Indian Express

time17-06-2025

  • Health
  • New Indian Express

Karnataka reconstitutes expert panels to revise healthcare package rates, private hospital norms

BENGALURU: In a move aimed at bringing uniformity and transparency to state-run health assurance schemes, the Karnataka government has reconstituted an expert committee to recommend standard package rates for medical services offered at participating establishments. The committee's primary task will be to evaluate healthcare costs and recommend uniform rates to be applied across public and private hospitals under government-supported insurance and assurance schemes. The effort is expected to reduce pricing disparities, improve access to quality care, and streamline reimbursements under schemes like Ayushman Bharat and state-run insurance programmes. 'The committee has been formed and the latest proposal highlights the need to revisit and update the existing package recommendations. Based on this, the government has formally amended the relevant rule and reconstituted the committee accordingly,' an order dated June 10 said. The newly formed panel will be chaired by the Additional Chief Secretary or Principal Secretary or Secretary to the Department of Health and Family Welfare. The committee includes key health administrators such as the Executive Director of Suvarna Arogya Suraksha Trust (SAST), the Health Commissioner, the Medical Education Director, and a representative from the Finance Department not below the rank of Deputy Secretary. A senior official from Sri Jayadeva Institute of Cardiology will represent tertiary public healthcare institutions. Govt forms panel to review private healthcare standard In addition to government officials, the committee also includes non-official members from institutes such as the Indian Institute of Public Health (IIPH), IIM-B, among others. To ensure uniform standards across private healthcare institutions in the state, the state government has reconstituted an Expert Committee to review and recommend norms for classification, infrastructure, staffing patterns and staff qualifications in private medical establishments. The reconstitution follows a proposal from the Health Commissioner who sought a revision of the committee's non-governmental members. The comm ittee will be chaired by the Health Commissioner and include senior officials from the Departments of Health, Ayush, and Medical Education. It will also have representatives from NIMHANS, PHFI, Indian Medical Association, and other bodies. The panel is tasked with reviewing and updating existing norms related to the classification of institutions, required infrastructure, staffing patterns, and minimum qualifications for medical personnel, in line with the Karnataka Private Medical Institutions (Amendment) Act.

Aadhaar now must for dialysis scheme benefits in Karnataka
Aadhaar now must for dialysis scheme benefits in Karnataka

New Indian Express

time15-06-2025

  • Health
  • New Indian Express

Aadhaar now must for dialysis scheme benefits in Karnataka

BENGALURU: The state government has issued a notification mandating Aadhaar authentication for availing benefits under the Pradhan Mantri National Dialysis Programme (PMNDP), implemented through the Suvarna Arogya Suraksha Trust. This is to ensure better service delivery, transparency, and to ensure entitlements are distributed efficiently. According to the Department of Personnel and Administrative Reforms (DPAR), both Priority Household (PHH) and non-PHH ration card holders must either furnish proof of Aadhaar or undergo Aadhaar authentication to avail the benefits. However, the government clarified that no individual, adult or child will be denied treatment for lack of Aadhaar. In such cases, other identity documents will be accepted, and a register will be maintained to track these for audit and review purposes. Aadhaar enrolment facilities will be set up at block or taluk levels where centres are currently unavailable. In cases where biometric authentication fails, due to poor fingerprint quality or other issues, the department has recommended alternatives such as iris or face scans, OTP-based authentication, or physical Aadhaar letters validated through QR code scanners.

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