The average cost of treatment under the Pradhan Mantri Jan Arogya Yojana (PM-JAY) at Jayadeva hospital, the largest public heart hospital in Karnataka, is three times higher than that at a private for-profit heart hospital, according to an analysis by Project Jeevan Raksha, a public-private initiative of Proxima.
The Sri Jayadeva Institute of Cardiovascular Sciences and Research (SJICR) has treated 15,224 PM-JAY beneficiaries in Bengaluru since the scheme was launched in 2018.
"The total value of bills for treating these beneficiaries is Rs 127 crore. The average cost of treatment per PM-JAY beneficiary is Rs 83,421. Strangely, this is three times costlier than that at a private for-profit heart hospital where the average cost of treatment per beneficiary was Rs 28,588," said Mysore Sanjeev, Convenor, Project Jeeva Raksha, which analysed the data given by the National Health Authority in response to an RTI application.
The analysis compares Jayadeva with Narayana Multispeciality Hospital, Ahmedabad, which treated 11,893 patients. "The total value of bills for treating these beneficiaries is Rs 34 crore. The average cost of treatment per PM-JAY beneficiary is Rs 28,588," the analysis concluded.
SJICR Director Dr C N Manjunath called the analysis of data "misleading". "The bottom line is that a hospital, government or private, cannot claim a single rupee more than what is fixed under the government scheme. Hence, the average cost of treatment per beneficiary cannot be different in two hospitals.
"Over the last three years, 17,795 patients underwent heart surgeries, angioplasties, and stent and pacemaker procedures at Jayadeva hospital, Bengaluru, alone. If this is divided against our claims of Rs 127 crore, the average cost per patient comes to around Rs, 74,000," he said.
Echoing him, cardiac surgeon Dr Devi Shetty, founder and chairman of Narayana Health, said: "Our data review shows cardiac surgery per patient cost Rs 1.06 lakh while cardiology procedure cost Rs 74,000 this year. The average cost of treatment per PM-JAY beneficiary cannot be as low as Rs 28,588. There seems to be a misrepresentation of data.
"For a general walk-in patient, our operational cost of performing a single vessel angioplasty including stent is Rs 2.35 lakh while the PMJAY only reimburses a bare minimum Rs 60,000."
Dr Manjunath pointed out that despite a double valve replacement costing the hospital Rs 2.25 lakh, the government scheme reimburses only Rs 1.5 lakh.
"We're incurring a loss of over Rs 50,000 per procedure. We lose of Rs 2.5 crore a year just to do procedures under PMJAY/Ayushman Bharat-Arogya Karnataka because the government capped the cost of a valve at Rs 35,000 but if the patient requires a better one, in their interest, we use the one that costs Rs 70,000 and waive those charges," he said.
Check out latest DH videos here