Scheme still a ‘work in progress’ as preparedness of states vary
REACH Several states began training of community health officers, others are expanding existing state schemes to offer hospitalisation cover, while still others have yet to sign up
NEW DELHI: Prime Minister Narendra Modi has set September 23 as the deadline for the nationwide launch of his government’s flagship health insurance programme, but preparedness varies widely among states.
Several states began six-month courses and hands-on training of community health officers more than a year ago, others are expanding existing state schemes to offer hospitalisation cover to everyone, while still others have yet to sign up to be part of the scheme.
On Independence day, Haryana became the first state to launch Ayushman Bharat in all 22 districts and Mausami, 27, from Ghisarpuri village in Karnal, became the first beneficiary of the cashless health insurance scheme when she delivered her baby girl Karishma through Caesarean section on August 17.
Mausami’s family did not spend any money on for the surgery, which cost ₹9,000 at the Kalpana Chawla Government Hospital in Karnal. Within a month, 1,900 beneficiaries were listed, and the treatment of 35 is underway under the Ayushman Bharat health insurance scheme that offers up to ₹5 lakh hospitalisation cover per year to 100 million families across India.
In Haryana, 1.5 million families (600,000 in urban areas, and 900,000 in rural areas) will be covered under the health insurance scheme, which will benefit an around five million persons.
While all government hospitals are empanelled, only 250 of the 2,400 private hospitals in the state have so far joined the programme.
State health minister Anil Vij is confident of scaling up services to reach all beneficiaries over the next few months. “It is not difficult, it’s just another way of serving our patients. In the past, a patient had to get a card made for free treatments, now he would have one already made by an Ayushman Mitra at every health centre. With the card, they would not have to pay anything, ever,’’ said Vij.
Patients are noticing the change. When daily wager Rekha, who goes by one name, was admitted at Karnal’s Civil Hospital for the delivery of her third baby, she was happy to find her name in the list of beneficiaries under Ayushman Bharat.
“We have not paid anything for the treatment and medicines yet,” said Rekha, 25, from Sekhupura Suhana village in Karnal district.
“The time we were here, we had to pay for medicines, besides other expenses but this time we paid nothing. This is a big support for people like us, who worry about medical expenses for their families all the time,” said Kumar, who is also a daily wager.
WORK IN PROGRESS
Work on the ground has started, but is still far from fruition. A separate office at the state level is being set up and the staff is being recruited, and the process of recruiting information and technology coordinators at the district level is underway. While 200 Ayushman Mitras have been recruited and trained, 100 more are required to be trained for the civil hospitals and other centres. The private health care sector has chosen to wait and watch. “Some of the conditions put up by state government for the private hospitals’ empanelment are not feasible, such as an ICU (intensive care unit) back-up and round-the-clock presence of a medical officer. Moreover, the rates for some treatment packages are too low and not viable,’’ said Dr AP Setia, former president of the state unit of Indian Medical Association (IMA). Others are reluctant to get empanelled because of a trust deficit in claim settlement or grievance redressal procedures. Despite screaming headlines in the media following Karishma’s birth, few people seemed to know about the scheme. Even in the chief minister’s home city Karnal, awareness is low.
“People either do not know about the scheme or how they can get in touch with an Ayushman Mitra,’’ says a health official.
The list of the beneficiaries is available at the website of Ayushman Bharat, yet people still harass doctors and other hospital staff for details, said Dr Piyush Sharma of Karnal’s Civil Hospital. As on September 8, the hospital had 14 beneficiaries on the Ayushman Bharat list.
According to Hisar deputy civil surgeon Jitender Singh, all patients who get admitted for treatment in public hospitals are now being informed about the scheme.it has created no ripples in Tamil Nadu, the state with arguably the best public health services in the country. “The scheme will hardly have any impact in a developed state like Tamil Nadu, which is a front runner in health insurance schemes over the years, such as Kalaignar Kappitu Thitttam, Amma health insurance scheme and now Comprehensive CM health insurance scheme,” said a surgeon at Rajiv Gandhi Government General Hospital in Chennai, who did not want to be named.
Tamil Nadu signed the memorandum of understanding with the Centre on Tuesday. “In Tamil Nadu, we would suggest the merger of the scheme to ensure that there is no overlapping of beneficiaries,” said state health secretary J Radhakrishan.
The CM’S health insurance scheme covers 15.8 million population and 1,027 procedures, offering a cover of ₹2 lakh for hospitalisations and serious ailments. “For rare surgeries, the expense is covered up to ₹30 lakh,” he said. The private sector in Tamil Nadu, too, is concerned about the low costs of packages. “For a Caesarian delivery, Ayushman Bharat will cover around ₹9, 000, but it would take around ₹20,000 for us (private sector). So, we have done a costing survey in a scientific way and have sent it to the Union government with a request to increase the rates. If the rates are revised, IMA would be glad to render its co-operation,” said J A Jayalal, president, IMA (Tamil Nadu chapter).