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The Modi Government’s pilot project Ayushman Bharat or Pradhan Mantri Jan Arogya Yojana (PMJAY), kick-started in September 2018, is facing a major setback due to low rates. As a result, multi-speciality and big private hospitals are unwilling to join hands with the government under the scheme.
The Quint has learnt that Dinesh Arora, Deputy Chief Executive Officer of the National Health Authority has issued a notification on 30 May to constitute a committee under the Ayushman Bharat scheme to review “appropriate package costing”, “anomalies” as recommended by specialist committees. The ten-member committee is headed by Arora.
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An email, accessed by The Quint, reveals that on 2 November 2018, Dinesh Arora, wrote to several private hospitals in Delhi, accredited under the National Accreditation Board for Hospitals & Healthcare Providers, “to join hands and serve the underprivileged sections of our community and ensure access to the best healthcare facilities”.
The Delhi government also refused to be a part of the Ayushman Bharat scheme. Since Delhi has the highest number of hospital beds in India, with a bed density close to 2.7 beds per 1000, Arora wrote to Delhi private hospitals with the hope to rope in maximum private hospitals under the scheme.
There are around 2000 tertiary care private hospitals in India. Sources have confirmed to The Quint that only about 1% of tertiary care or multi-speciality private hospitals have enrolled under the Ayushman Bharat scheme, which means hospitals like Max, Medanta, Fortis, Apollo etc have not agreed to come on board with the Ayushman Bharat Yojana. In fact, several nursing homes have also refused to get empanelled.
The Quint has written to the Ayushman Bharat Yojana authorities to get the exact number of tertiary care hospitals under the scheme. But we haven’t received their response yet.
Around 7,800 private hospitals across the country have been enlisted in the scheme. But did these private hospitals enrol because of Ayushman Bharat? NO.
Around 80-90% of these private hospitals are those which were already enlisted under the state health schemes, say experts. Most of these are small nursing homes/hospitals with 25 to 30 beds. Hence, they automatically got enrolled under Ayushman Bharat.
Around 1,300 medical procedures are covered under the Ayushman Bharat Yojana. Rates for most procedures are found to be unfeasible and it is believed that government is in the process of revising some these rates.
It is interesting to note that the rates under the Ayushman Bharat scheme are on an average 30% less than CGHS rates, which are considered low as per current industry standards, and the government is also believed to be working on their revision by about 20%. Hence, to bring the rates under Ayushman Bharat close to industry norms, these have to go up on average by 50%.
Except for Delhi, Odisha and Telangana, all other states have implemented the Ayushman Bharat Yojana family health insurance scheme. Some states like Maharashtra, Tamil Nadu, Gujarat, Karnataka and Rajasthan were already running their own health schemes for Below Poverty Line category of population. Now, these states have merged their health schemes with Ayushman Bharat Yojana.
The rates of medical procedure in these states are much higher than in comparison to Ayushman Bharat scheme. The Ayushman Bharat authorities allowed states to use their health scheme rates even when patients under Ayushman Bharat were treated. It led to two things:
The Association of Healthcare Providers (AHPI), a not-for-profit organisation, is closely working with the Health Ministry on the Ayushman Bharat scheme. From the very inception of the scheme, AHPI had been raising the issue of rates with the Health Ministry.
One of the criterion to revise the rates of scheme, as suggested by AHPI, is to match Ayushman Bharat rates with the highest rate of medical procedures provided under state health schemes. AHPI prepared a list of medical procedures rates comparing them between Ayushman Bharat Yojana and the rates applicable in Telangana, Maharastra, Tamil Nadu and Karnataka.
These are just two examples of several medical procedures provided under the Ayushman Bharat yojana.
Under the Ayushman Bharat, the beneficiary family gets Rs 5 lakh of medical insurance per annum, which will remain unchanged. But since the rate per medical procedure will increase, the government will have to increase cash flow to reimburse the bills of the hospitals.
Experts say, the Health Ministry has to deal with this problem initially after the revision of the rates but with time, the system will fall in place.
The Modi government has claimed that Ayushman Bharat scheme will provide health insurance to 10 crore poor families, meaning roughly 50 crore people will be benefitted under the scheme with Rs 5 lakh insurance per annum. The government claims in nine months over 29 lakh people have benefitted under the scheme – less than 1% of the total beneficiary.
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