Doctors say protocol for Vajpayee Arogyasri Yojana tough to implement

Arjun and Bharati (names changed) — both cancer patients — travel nearly 100 km from their village in Kundapur in Udupi district to Mangalore for their treatment. It is a journey they can ill-afford, for both come from the below poverty line (BPL) category.

They were forced to travel to Mangalore because Kasturba Medical College (KMC) — the only hospital in Udupi implementing the scheme — stopped it a few months ago.

Now, Arjun and Bharati are being treated in Father Muller Medical College Hospital under the Vajpayee Arogyasri Yojana, a government scheme for people living below the poverty line.

M. Dayananda, Medical Superintendent, KMC, Manipal, said the hospital was not treating patients under the scheme anymore as “it is not possible (to treat them) as per their (government’s) conditions. They have some restrictions such as which medicines to use and how to go about administering them… But we get better results with our drugs”. He said KMC doctors did not agree with the government’s guidelines for the scheme.

Other doctors from hospitals implementing the scheme in Udupi and Mangalore told The Hindu that the scheme was “rigid”.

Dr. Dayananda said that the KMC was unwilling to work within the prescribed package as the amount being offered was low and that it had tried its best to keep costs low for the patient. KMC completed chemotherapy treatment within a day to avoid the expense of admission to hospital for the patient and provided medicines at rates below the maximum retail price, he said.

The Medical Superintendent said the hospital had to submit a 15-minute video of the patient’s treatment to claim reimbursement, making the scheme more bureaucratic.

Another issue was that the payment to the hospital for treating the beneficiaries was delayed. While the hospital surely got paid, he said the process was “not smooth”.

Ramachandra Bairy, District Health and Family Welfare Officer (DHO), Udupi, said “They (KMC) are not happy with the amount being given by the government of Karnataka. They are not happy with the package. It is their choice. So we (doctors from Udupi) are referring people to Father Muller.”

He said nursing homes in Udupi could only perform chemotherapy and surgeries but they could not perform radiotherapy.

FMMCH executives said that the hospital had received 10 to 12 patients through the scheme in the last one and a half months.

An FMMC oncologist said that the treatment protocol may not be always applicable to the patient and therefore most oncologists would not agree with the government-advised treatment. “Some flexibility (in the protocol) is required to help the poor. Otherwise, the scheme is good as it covers chemotherapy and surgery for poor patients,” he said.

Another oncologist in the city said the patient sometimes required a drug or a radiation dose different from what was advised in the scheme.

But the doctors could not give it because the scheme is “very rigid”.

The treatment protocol advised in the scheme appeared to be framed by somebody outside the profession. “They are not specialists and they have given some guidelines to follow. That is the problem,” he said.

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