The Union health ministry, in consultation with the private and public agencies, has drafted a list of 2179 medical treatment procedures to be used as master list of procedures under various government and private insurance schemes.
The ministry, with a view to streamline the health insurance procedures and restrict the allegations of misappropriations by the hospitals, has held consultations with stakeholders like CGHS, RSBY, Rajiv Arogyasree, Indian Medical Association, Health Institutions, FICCI, private insurance schemes etc. to prepare the comprehensive master list.
The purpose is to develop a master list of procedures containing standard nomenclature and description of the procedures. It is envisaged that the medical treatment procedures covered under any insurance scheme should be from this master list only.
Accordingly, the Government has sought responses and comments from different stakeholders like insurance companies, hospitals, clinical establishments and consumer groups to make further additions or omissions in the draft list.
There were mounting allegations, especially on the part of the insurance firms that the hospitals were exploiting the insurance schemes with unnecessary procedures and also the confusion and complications come up about whether some procedures were included or not.
Over 300 procedures under general surgery, more than 120 ENT surgery procedures, around 150 procedures under gynaecology and obstetrics, 200 under orthopaedics, several procedures under physiotherapy, surgical gastroentrology, endoscopic procedures, cardiothorasic surgery, paediatric surgery, neurosurgery, ophthalmology, surgical oncology, medical oncology, radiation oncology, plastic surgery, polytrauma, cochlear implant surgery (CIS), prosthesis, dental surgery, critical care, general medicine, infectious diseases, paediatrics, cardiology, pulmonology and dermatology are in the list.
The list includes even minor procedures like dressing of wounds, removal of stitches, sterl puncture etc. Injection for haemorrhoids , injection for varicose veins, catheterisation, dilatation of urethra, incision & drainage, intercostal drainage, peritoneal dialysis , general surgery, hemithyroidectomy, resection enucleation– thyroid, subtotal thyroidectomy, gastrostomy, pyloromyotomy, partial/subtotal gastrectomy, and cholecystostomy.