Over 65 lakh patients were provided treatment worth 9,549 crore under the Centre’s flagship Ayushman Bharat Pradhan Mantri Yojana (AB-PMJAY) till December 5, MoS Health Ashwini Choubey recently informed Rajya Sabha. Out of the total 65,45,733 patients, treatment amounting to 6,133 crore was provided to 35,34,695 through private hospitals, he said in Rajya Sabha.
Under the AB-PMJAY, 1392 health benefit packages and their rates have been defined for providing secondary and tertiary healthcare to the beneficiaries at the empanelled hospitals. In addition, there is one unspecified surgical package as well.
In a written reply, the minister dismissed there being any clash between government and private hospitals over the rate that insurance companies would pay to hospitals under the scheme. “However, feedback on various aspects of scheme, including the package rates, was received from various stakeholders, including hospitals, and an exercise for rationalization of health benefit packages has been completed to remove anomalies,” he said.
Under the health insurance scheme, the Centre and state’’s ratio of contribution towards premium is 60:40 in all the states except the northeast and the Himalayan region, where the ratio is 90:10, the minister of state for health said in reply to another question. In the case of Union territories, the central contribution of premium is 100 per cent for UTs without legislature and 60 per cent for UTs with legislature. The central government’’s contribution of premium is subject to a ceiling rate to be decided by the government from time to time.
A total 1013.76 crore has been released under the AB-PMJAY for the financial year 2019-20, while for the previous year the amount stands at 1849.55 crore. Choubey clarified that there is no proposal to include certain ayurvedic, yoga, unani, siddha and homoeopathy (AYUSH) treatment packages in the scheme.
The AB-PMJAY provides health cover of 5 lakh per family per year to around 10.74 crore poor and vulnerable families identified from Socio Economic Caste Census database on the basis of select deprivation and occupational criteria in rural and urban areas, respectively. In addition to these 10.74 crore families, many states have identified more groups of beneficiaries for their similar health cover schemes, which are implemented in alliance with the AB-PMJAY.
Choubey also said that the Ayushman Bharat scheme will generate employment of 1,20,000 community health officers who will be placed at health and wellness centres by 2022.
As part of Ayushman Bharat – Health and Wellness Centres (AB-HWCs), all the sub health centres, primary health centres and urban primary health centres are to be upgraded into HWCs to deliver comprehensive primary health care. The plan is to create 1,50,000 HWCs by financial year 2022. “As per the implementation plan, 1,20,000 community health officers will be placed at the SHC level AB-HWCs by 2022,” Choubey told Rajya Sabha.
The AB-PMJAY, which aims to provide health cover of 5 lakh per family per annum to around 10.74 crore poor and vulnerable families, has created impact towards generation of employment, both short term and long term in nature, Choubey said.
The hospitals empanelled under the scheme are required to have ‘Pradhan Mantri Arogya Mitras’ for managing the helpdesk and other related activities.
Further, implementation of the AB-PMJAY will lead to increase in demand of healthcare, both in public and private hospitals, resulting in increased demand of doctor, paramedics and all professional jobs which are necessary for setting up and augmentation of health infrastructure, he said.
The design of AB-PMJAY is robust and implementation during the first year has been successful, he said. However, awareness under the scheme needs to be increased to improve the reach of the scheme. The access to quality health care services can be improved by empanelling more private hospitals across all the geographies. Also, capacity needs to be continuously improved at all levels of implementation, he added.
States and UTs are being regularly oriented on the challenges in the implementation of AB-HWCs. Elaborating the steps taken for effective implementation of the AB-PMJAY, the minister said the health insurance scheme is being governed on a zero-tolerance approach to any kind of fraud.
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