Gujarat has witnessed a significant decline in the number of claims processed daily under the Pradhan Mantri Jan Arogya Yojana (PM-JAY) scheme following a medical malpractice incident. From an average of 3,800 claims per day between May and October, the figure dropped to 2,700 per day—a 30% decrease—after two patients under the scheme died due to a botched angioplasty at Ahmedabad’s Khyati Hospital on November 11.
In response to the incident, the state government introduced stricter standard operating procedures (SOPs) for commonly sought medical procedures to curb malpractice. Over the past month, 12 hospitals and several associated doctors have been removed from the PM-JAY scheme by the state health department.
While these measures aim to protect patients, they have also resulted in delays for those seeking treatment under the scheme, particularly in private hospitals. An anonymous CEO of a PM-JAY-affiliated Ahmedabad hospital explained that the approval process for procedures like angioplasty now requires additional documentation, such as blood tests and TMT results, significantly increasing processing times.
“Earlier, approvals took about 45 minutes if all documents were in place. Now, it takes two to three times longer, especially for smaller or newer hospitals,” the CEO said, adding that hospitals with stronger track records faced fewer issues.
Dr Bharat Gadhvi, president of the Ahmedabad Hospitals and Nursing Homes Association (AHNA), confirmed that procedural delays and a lack of trust among patients have contributed to the drop in claims. “The decline is around 30% in Ahmedabad, with daily procedures falling from 200 to 140,” he said.
While welcoming the increased scrutiny, Dr Gadhvi acknowledged the system’s current instability. “We are convening a meeting to ensure smoother implementation of the scheme,” he added, citing patient apprehension regarding hospital safety and scheme reliability.
A senior health department official noted that the overall number of claims generated remains consistent at approximately 1.1 lakh per month across Gujarat’s 1,700 government and 900 private hospitals. However, the official acknowledged that delays might disproportionately affect private facilities.
State Health Minister Rushikesh Patel denied any significant reduction in PM-JAY beneficiaries, attributing the drop to a crackdown on fraudulent claims. “Genuine patients will continue to receive benefits. We have enhanced scrutiny to prevent exploitation of the system,” he said.
Medical practitioners and hospitals have expressed concerns about the new SOPs, particularly smaller private facilities. Cardiologists and other specialists recently met health department officials seeking clarity on the requirements for compliance with the revised procedures.
While government hospitals have seen little change in patient numbers, private facilities, especially smaller ones, bear the brunt of the stricter regulations.
Over the past three years, a total of 3,842 surgeries were performed under the Pradhan Mantri Jan Arogya Yojana (PM-JAY), with 112 patients dying either during or following these operations.
On Nov 9, five hospitals in Gujarat have been suspended from the list of authorised healthcare providers under the Pradhan Mantri Jan Arogya Yojana (PM-JAY) scheme following a series of irregularities discovered during inspections. Two of these hospitals are based in Patan, with one each from Ahmedabad, Dahod and Aravalli. Alongside the suspensions of these hospitals, two doctors have also been removed from the list of medical professionals permitted to offer services under the scheme.
The suspensions followed thorough inspections by the State Anti-Fraud Unit (SAFU), in collaboration with expert medical teams, which uncovered multiple instances of fraudulent activities linked to the hospitals.
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