The Rajiv Gandhi Jeevandayee Arogya Yojana (RGJAY) was introduced in Maharashtra in July 2012 & Seven Hills Hosp. was roped in by the State Govt. to be one of the major hospitals to implement the scheme. It had been pointed out earlier by health activist Anant Phadke of the JAA how the scheme needs to be re-examined before being implemented.The following is an extract of an article by Amit Sengupta dated Nov. 7th 2012 written in “Newsclick” Changes have been made to make it easier for the lay reader to grasp the gist of what Sengupta wrote: In 2007 the Govt. of Andhra Pradesh launched an insurance scheme (called Arogyasri) that was designed to protect poor patients from the ‘catastrophic’ impact of out of pocket expenses incurred on hospital care. Similar state level schemes have also been launched or are in the process of being launched in some other states, Maharashtra being one of them (RGJAY). The potential benefits of the scheme need to be assessed against the drawbacks to make an impartial judgement: 1. It is being claimed that these initiatives will protect people from the impact of catastrophic expenses on medical care, because of which an estimated 6 crore people are driven below the poverty line every year. 2. Like any insurance package these schemes have a ceiling for reimbursement. In Maharashtra it is Rs. 1.5 lakhs per family per year which is a reasonably good sum. . 3. These schemes are publicly funded – i.e. the annual premiums for beneficiary families are paid by the Government. 4. The schemes have the advantage of being cashless, i.e. payments are made directly to the provider and patients do not have to pay themselves. Before going to the disadvantages of the scheme one needs to point out the following: 1. All the schemes have a list of procedures which are covered & reimbursements are limited to this list. Moreover, hospitalization is a prerequisite to get reimbursement.. 2. "Accredited" institutions can be in the public or the private sector. In practice, a large majority of accredited institutions are in the private sector. Some of the major drawbacks of the scheme are the following: 1.Beneficiaries are insured only against a set of ailments that require hospitalization. So beneficiaries are not guaranteed care for all ailments – in other words it is not a promise to provide comprehensive health care, but to provide care for a pre-defined package of procedures. Patients are ideal candidates for being enticed by the private sector, especially the well resourced corporate hospital chains. They are enticed by fraudulent claims hidden in the garb of technical jargon. In the past few months there have been several stories in the media regarding the sharp rise in hysterectomies (operations involving removal of the uterus) since the introduction of the Govt. insurance scheme. In Chhattisgarh, the director of health services, under public pressure, appointed a fact-finding team and suspended doctors involved in 22 cases, where it could be proved that the operations for hysterectomy were conducted without medical reasons. Dainik Bhaskar reported that just one private hospital (Gupta Hospital in Dhamtari) conducted 604 hysterectomies in 900 days. In comparison, the government-run Ambedkar Hospital in Raipur conducted just seven such operations in the same period. Other media reports indicated that In Bihar an estimated 16,000 hysterectomies, most of them deemed unnecessary, have been conducted. Everybody in the know acknowledges that these reports are just the tip of the iceberg. Unethical practices have become the cornerstone of the Insurance scheme in many parts of the country – leading to unnecessary investigations, medication and surgeries that only help the profit hungry providers.2. It has been reported how ‘Arogyamitras’ are appointed by private hospitals to scout around for patients who can be enticed to get operated upon in private hospitals. 3. The private hospitals also ‘cherry pick’, i.e. they pick and choose those patients that provide the highest returns and refer others to government hospitals. They refuse patients who are likely to have poor outcomes or are not likely to provide good returns. This is thus the kind of choice that the poor and vulnerable are provided – a choice based on false motivations and enticements by profit hungry private hospitals.