Hernia surgeries, common dental procedures and non-emergency appendectomy surgeries cannot be done under the Swasthya Sathi scheme in private hospitals, the state health department has said.
A senior official said the decision was taken to keep beds under the scheme in private hospitals free for more complex procedures.
The Telegraph had reported on August 4 that many medical superintendents of government hospitals have complained to the department that simple procedures and treatments like hernia have almost stopped at hospitals because patients and a section of doctors are interested to get them done at private facilities under the Swasthya Sathi scheme.
The Swasthya Samiti of the department issued two advisories on Thursday to impose the bar on such “simple procedures” at private units.
Hydrocele surgeries; most hernia surgeries; dental procedures like scaling, dental filling, pulp capping, all types of crown and bridges, prosthesis, including complete denture and the removable partial denture and cosmetic dental procedure cannot be done in a private hospital under the health scheme.
But there are some exceptions: obstructed hernia, strangulated hernia, incarcerated hernia and any other life-threatening situation arising from any hernia.
A doctor said these were complex procedures. Exceptions can also be made for prostheses for trauma patients, cancer surgery patients and maxillofacial patients.
Proper documentation will be required to get the health scheme benefits, the advisory said.
The department has also barred appendectomy as an ancillary procedure to any other abdominal procedure.
“Many doctors do appendectomy while any other abdominal procedure is being done. This raises the bill, which for Swasthya Sathi patients, is paid by the state. There is no need to do an appendectomy when there is no appendicitis,” said a doctor.
“We are able to perform all the surgeries barred by the advisories at government-run hospitals. If these surgeries are done in government hospitals, more beds will remain free in private hospitals where more complex surgeries can be done,” said a health department official.
