New Delhi: The Narendra Modi government is likely to expand the coverage of its flagship health insurance scheme — Pradhan Mantri Jan Arogya Yojana (PM-JAY), also known as Ayushman Bharat — from 40 per cent to 70 per cent of the total population, according to an official document accessed by ThePrint.
An internal study conducted by the National Health Authority, an agency responsible for implementing PM-JAY, said, “The scheme is expected to expand to cover about 70 per cent of the population over time as both centre and states add several more vulnerable sections of the society to this cover.”
The NHA conducted the study along with the Insurance Regulatory and Development Authority of India.
Launched on 25 September last year, on the birth anniversary of RSS ideologue Pandit Deendayal Upadhyaya, the cashless scheme provides an annual health cover of Rs 5 lakh per family to more than 10.74 crore poor families — about 50 crore people.
The scheme covers secondary and tertiary care hospitalisation, which includes critical procedures, including cardiac surgeries, organ transplants, and fixing stents and implants.
If the scheme is expanded to cover 70 per cent of the population, it will end up providing health cover to more than 90 crore people.
ThePrint had earlier reported about the government’s plan to expand the coverage under the scheme.
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Delhi, Telangana, Odisha yet to join the scheme
The NHA data stated that 17 states and union territories (UT) have already replaced their own health schemes with Ayushman Bharat. Eleven of these states are BJP-ruled, while the rest are non-BJP states/UTs — Madhya Pradesh, Kerala, Punjab, Tamil Nadu, Andaman and Nicobar, and Andhra Pradesh.
“The response from states across India is phenomenal. Initially, there were challenges of convergence in those states who had their own health schemes, but now they are adequately addressed. With more than 25,000 admissions (of patients) per day, we have exceeded 40 lakh admissions under the scheme,” Dr Indu Bhushan, Chief Executive Officer, Ayushman Bharat, told ThePrint.
West Bengal had merged their own health scheme with PM-JAY, but later pulled out of it.
Three states — Delhi, Telangana, Odisha — are yet to join the scheme and the government has stopped making efforts for it, Bhushan said.
“We have spoken to them earlier and have shown evidence on how and why they must join the scheme. The scheme is good for people, good for the finances of the states and the overall health sector. However, rest is their choice and we have now left it to them. Right now, we are not making any proactive efforts to bring them onboard,” he added.
Bhushan did not comment on the government’s expansion plans under the scheme, but added that there’s a need to address several challenges in the present ecosystem before Ayushman Bharat enters its second phase.
“I would first fix the challenges that keep coming every day. We are working on improving the overall capacity building, IT framework for data standardisation and checking frauds,” he added.
Scheme helped people save Rs 13,000 cr in last one year
With focus on enrolling more multi-specialty tertiary hospitals with specialties ranging from cancer treatment and cardiac surgeries in the second phase, the scheme, in the last one year, has registered over 18,000 hospitals, including over 9,000 private hospitals.
“With an expenditure of around Rs 6,500 crore, the government (through the scheme) has delivered services worth Rs 13,000 crore to the most vulnerable population of India,” Bhushan said.
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Gujarat tops in admitting patients under Ayushman Bharat
A total of 43.93 lakh patients have been admitted under the scheme until 9 September this year, according to the NHA. Gujarat (8.42 lakh) tops the list in admitting patients followed by Tamil Nadu (6.11 lakh) and Chhattisgarh (5.62 lakh).
Procedures for cardiology, cancer and organ replacements have been the most sought-after among patients.
The NHA data said one- and two-stent angioplasty tops the list of packages offered under the scheme, followed by radiotherapy, knee replacement and hip replacement.