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Empowering Hope | Watch: Dr. Prriya Espuniyani & Vivek Sharma Unveil Health Scheme Insights!

Empowering Hope | Watch: Dr. Prriya Espuniyani & Vivek Sharma Unveil Health Scheme Insights!

Health Horizon Unveiled: Dr. Prriya Espuniyani & Vivek Sharma Empower Hope with Exclusive Health Scheme Insights!

Vivek Sharma: Hello. My name is Vivek Sharma, and you must have seen me on Uhapo, LungConnect, CRSF, and many other healthcare platforms. I convey mind-blowing facts and information on cancer and mental health. Today, we are here to discuss a very specific topic that affects almost all cancer patients, and I’m saying almost because it affects around 80-90% of people around the globe. Today, with us we have Dr. Prriya Espuniyani, a cancer surgeon, who has gained expertise in thoracic Surgery and Surgical oncology through her immense work at Tata Memorial Hospital. Hello, Dr. Prriya, and a very warm welcome to our YouTube channel. Thank you so much for taking the time for our viewers. 

Dr. Priya Espuniyani: Thank You So Much Vivek!

Vivek Sharma: Sure, let’s break it down. Today, I want to discuss a serious topic. In recent months, I’ve noticed many patients facing financial challenges due to cancer. Dealing with cancer can be expensive, and when prices go up, it becomes even more challenging for people. Some openly share their struggles, but others avoid talking about it.

People usually plan for various life events like weddings, education, and buying a house or car. However, when it comes to health, especially dealing with a tough disease like cancer, many don’t plan ahead. People often believe they won’t be affected by such diseases because they think they are doing everything right. But when they face such situations, they realize they lack resources and don’t know what to do. That’s when they start looking for government schemes or seek help from NGOs. Unfortunately, relying on these schemes doesn’t always work out, especially for the middle-class population.

Today, I want to discuss our health scheme, highlighting both its strengths and areas for improvement. My first question to you is: What are your thoughts on schemes like Ayushman Bharat? Do you think these initiatives effectively address the health concerns of the people, especially at the state level?

Dr. Priya Espuniyani: Absolutely. First of all, I want to thank you for reaching out, and I understand you’re interested in knowing about the available schemes in our state. We can definitely talk about that now. However, maybe in our next conversation, we can also discuss health insurance.

Vivek Sharma: Yes, and we will discuss it today too on the health insurance.

Dr. Priya Espuniyani: Sure, let me simplify that for you. The schemes we have in our country, whether on a national or state level, are pretty good when it comes to covering routine surgeries like gallbladder, appendix, and hernia. These surgeries are not very expensive, and the hospital stay is usually short, just two to three days. Even if someone undergoes surgery or receives telemedicine treatments, they don’t need to stay in the hospital for a long time, and these procedures don’t require many instruments. Private hospitals can handle these well. However, when it comes to certain surgeries like lung surgery, the government schemes may not cover the longer hospital stays that are needed, which can be around seven days.

Additionally, the patient needs to spend one or two days in the ICU. We also have to administer anesthesia and use machinery for the lung surgery treatment. The tube required for this procedure usually costs between 5,500 Rs to 6,000 Rs at the MRP. We also use staplers to close the veins of the windpipe, and one stapler is priced at approximately 13,000 Rs at MRP. So, even if we don’t consider the maximum retail price (MRP), the basic cost of the lung surgery would be around 50,000 Rs to 60,000 Rs.

Ignoring that, even if a hospital requires a seven-day stay, there are costs associated with the ICU, surgery, physiotherapy, and more. However, hospitals cannot afford such a substantial amount from their own funds, and the government support is not sufficient to cover the entire expense of treatment and surgery.

There is a scheme where the patient receives a package of 15,000 Rs to 20,000 Rs. Trying to cover the entire cost with such a small package is almost impossible for hospitals. It is not feasible physically, mentally, emotionally, or financially for both patients and hospitals. Therefore, private hospitals opt out of these kinds of schemes.

The doctor will provide you with a list of treatments needed for an individual. Based on that, hospitals will determine the cost and treatment package. However, with the package released by the government in the scheme, hospitals cannot sustain providing free treatment. Consequently, many hospitals withdraw from these government schemes due to the lack of profit and no-loss scenario. Some good hospitals and doctors choose not to participate in these schemes. Instead, they prefer to offer treatments to patients at a lower cost. Therefore, I believe the involvement of private corporate individuals is necessary. This is why doctors and the finance department should be part of creating these schemes, not just government officials and government hospitals. This is the main reason I think schemes are not adopted for major surgeries but only for basic surgeries in hospitals.

Vivek Sharma: You brought up an important point. However, I believe cancer is a significant issue today because the number of people diagnosed with cancer is increasing every year. Therefore, there is a need to focus on this. Some people mention a scheme where you can receive healthcare insurance worth lakhs for your future.

But when it comes to insurance, we often don’t understand how these schemes and the insurance system operate. So, let’s discuss government schemes. What exactly does it mean when they mention a scheme of 5 lakh rupees? What does this scheme generally cover? Does it imply that if someone gets cancer, their entire treatment will be covered, or will they only receive 5 lakh rupees?

Dr. Priya Espuniyani: Let me explain that everything comes with a price. For instance, if your appendix surgery costs between 25,000 to 30,000, the government will provide the hospital with ₹30,000 for performing the patient’s appendix surgery. However, in certain situations, where the government offers ₹50,000 for lung surgery but the overall cost is 1,50,000 Rs, hospitals tend to opt out of these schemes in advance. On the other hand, private insurance companies are more adaptable when it comes to assessing treatment costs.

Therefore, if your treatment amounts to about 50,000 Rs and your surgery limit is ₹50,000, the government will bear expenses up to ₹50,000. Beyond that, any additional costs have to be covered by the hospital itself. The hospitals participating in these government schemes have to manage all aspects of the patient’s care, as they want to maintain a good relationship with the government and avoid facing consequences.

Vivek Sharma: And does the cost arrives in time from the government side?

Dr. Priya Espuniyani : No comments.So, to clarify, with ₹50,000, the hospital has to cover all expenses. This implies that whether the treatment lasts for five days or 50 days, the hospital receives the same fixed amount. This results in significant losses for hospitals.

Vivek Sharma: This is a serious concern for me because I think the government needs to pay careful attention to it. If you are a patient advocate, a patient, a doctor, or someone who believes they can contribute, join us to form a group where we can appeal to the government. I believe it’s essential to involve stakeholders in policy-making at every level. My next question for you, doctor, is sometimes we feel like we’ve been fooled, deceived, especially when it comes to insurance. The insurance scenario in our country is quite distressing. It seems like a process focused on making money, but at what expense? They need to consider that too. Health insurance, in particular, has so many inclusions and exclusions, promising money after three or ten years with no clear end. One frustrating aspect is the smoker and non-smoker classification. Whether I’ve paid a premium of ₹25,000 or ₹50,000, it shouldn’t matter if I’m a smoker or a non-smoker; you should address my concerns based on my needs. Does that make sense?

Dr. Priya Espuniyani: The insurance companies don’t decide these things on their own. In the U.S., insurance companies cover everything, even in China. China, being a country with a high incidence of lung cancer due to heavy smoking, has comprehensive insurance coverage. However, in India, it’s the government that falls short in providing insurance packages for heavy smokers. The government directs insurance companies not to offer cancer scheme benefits to smokers.

The Indian government treats it like a business and instructs insurance companies not to offer any benefits if someone gets cancer from heavy smoking. Many people in our country think that the government supports us, while private hospitals don’t. However, the reality is different. The central government should now create policies because the number of smokers and the cancer rate are increasing rapidly in our country. Now, every third person is a smoker.

It’s not that lung cancer doesn’t get insurance coverage. However, when it comes to screening for lung cancer, the CT scan we promote, including conferences, has a first criterion that the patient must be a smoker. If you don’t admit to being a smoker, how will you undergo screening? If you do get the screening done, the company and the radiology center conducting the screening will face issues because they’ll be questioned about exposing the patient to radiation when the patient isn’t a smoker. In our country, we can discuss low-dose CT scans, but we can’t implement programs for it because people hesitate to declare themselves as smokers. Until the government understands the extent of our problem at the grassroots level, there won’t be any improvement.

Vivek Sharma: That’s really impressive and practical. Government agencies are actively collaborating with us to bring about necessary changes for the benefit of patients. There might be a time when doctors will say, “Brother, I won’t treat you. I won’t treat you because it’s not sustaining my home.”

So, if you are policymakers, please listen to us and involve us in decision-making for a significant impact. Thank you, Dr. Priya. Stay tuned for more informative videos on cancer.

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