68% of Ayushman beneficiaries get treatment in pvt hospitals

68% of Ayushman beneficiaries get treatment in pvt hospitals

Courtesy : Nationalist Bureau27/11/2018 13:15

New Delhi: Around 68 per cent of the 2.3 lakh beneficiaries of the Centre’s ambitious Ayushman Bharat health insurance scheme received treatment at private hospitals, with Gujarat, Tamil Nadu, Maharashtra and West Bengal topping the list.

Under the Pradhan Mantri Jan Aarogya Yojana — the secondary and tertiary care arm of the government-funded health insurance scheme — 2,32,592 beneficiaries were hospitalised within less than two months of the health insurance scheme’s launch on September 23, according to data provided by the National Health Agency (NHA).

It shows that oral and maxillofacial surgery, general surgery, ophthalmology and gynaecology were among the most sought-after treatments during hospitalisation.

As these include head surgeries, there is a possibility that accident cases constitute a significant number of claims.

These statistics assume significance as initially private hospitals had expressed concerns about the low pricing of packages fixed by NHA. This had also led to speculation about the durability of the scheme, which requires a network of empanelled hospitals across the country.

The data shows NHA has so far received 55,482 applications for hospital empanelment. Out of this, nearly 15,000 hospitals have either been empanelled or are in the pipeline following approvals. Around 8,000 empanelled hospitals are from the private sector.

“Costing issues are primarily in Delhi and in other metro cities where the cost of services and human resources is high. Otherwise, the responses in tier two and three cities in states like Haryana, Uttar Pradesh, Jharkhand and Chhattisgarh are tremendous,” deputy chief executive of Ayushman Bharat Dinesh Arora said.

Prime Minister Narendra Modi had on September 23 rolled out the Ayushman Bharat-Pradhan Mantri Jan Aarogya Yojana (AB-PMJAY), touted as the world's largest healthcare scheme, in Ranchi, Jharkhand.

The insurance scheme provides an annual health cover of Rs 5 lakh per family for secondary and tertiary care hospitalisation.

Through this scheme, the government aims to raise healthcare accessibility while reducing out-of-pocket expenditure on it. While out-of-pocket payments constitute over 60% of health financing in India, many are still deprived of tertiary care because of its high cost.

“Our target is to increase accessibility of tertiary care by 6,000 to 7,000 patients per day,” Arora said.

The government recently clarified that the National Accreditation Board for Hospitals (NABH) is not mandatory for the hospitals to get empanelled under the scheme. However, hospitals with NABH/NQAS accreditation can be incentivised for higher package rates subject to procedure and costing guidelines.

Also, the basic empanelment criteria allow empanelment of a hospital with a minimum of 10 beds, with the flexibility provided to the states to further relax this if required.

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