New Delhi: The Modi government’s flagship health insurance scheme, Ayushman Bharat – Pradhan Mantri Jan Arogya Yojana (PMJAY), hasn’t had a significant role to play in Covid-19 so far as the bulk of the treatment is being done in government hospitals. But this could change if there is a surge, said Dr Indu Bhushan, CEO of PMJAY and National Health Authority (NHA).
In an exclusive interview to ThePrint this week, Bhushan said, “I hope it does not happen but if there is a surge in the number of Covid cases and the public sector is not able to take care of them all, then the number of cases in the private sector will increase.”
So far, there have been just 281 claims for Covid-19 treatment submitted, according to data from NHA, the nodal body for PMJAY. Some states are yet to send their figures to the office.
However, the NHA is still supporting the government in its response to Covid-19. Using data analytics, the NHA team monitors the number of ILI and SARI cases that come in, and the hospitals they are reported from, on a daily basis.
ILI stands for ‘influenza like illnesses’ with symptoms like cough, fever, sore throat. SARI is ‘severe acute respiratory illnesses’, where patients are admitted with pneumonia and breathlessness. Both have Covid-like symptoms.
According to India’s apex research body, the Indian Council of Medical Research, all cases of ILI and SARI must be tested for Covid-19.
“If we see any hospital with more than five cases, we flag them to the NCDC (National Centre for Disease Control),” said Bhushan.
As of now, the NHA is seeing about 200 SARI cases daily. While the government sector has been testing most SARI cases they are getting, private sector hospitals have to be prodded.
“We are ensuring that they are sending the samples for testing by keeping it as a condition to get their (hospital) claims processed,” he said.
The NHA has also called all the PMJAY beneficiaries who are in the high risk category – over the age of 60, or suffering from diabetes or kidney disease – to talk about precautions to be taken and seeking care in case of symptoms, he said.
The NHA has also asked the states to negotiate with private hospitals on Covid-19 treatment prices, and is in the process of finalising the rates, said Bhushan.
The agency is ensuring that prices remain low and affordable while maintaining quality, he said. The price of RT-PCR test, for instance, has been negotiated by many states at rates below Rs 4,500 that the ICMR has set, he added.
The scheme provides healthcare cover of Rs 5 lakh for hospitalisation costs to over 10.74 crore poor and vulnerable families.
Aarogya Setu app, Covid helpline
The NHA is also running the Covid-19 helpline and fielding 40,000 calls every day, said Dr Indu Bhushan.
The agency’s team is also calling the users of Modi government’s health app, Aarogya Setu, based on their symptoms, and ensuring that they get tested. Moreover, it is also helping the Union health ministry in identifying the details and locations of the cases, he added.
‘Private hospitals fearful’
Amid the pandemic, private hospitals have mostly been missing from action — either shutting shop or refusing treatment to patients — even though 72 per cent of rural and 79 per cent of urban Indians depend on them for healthcare needs.
Dr Indu Bhushan agreed that private hospitals have been fearful and conservative, and running on reduced levels of operations but that is also because of people’s reluctance to go to the hospitals.
Hospitals are under stress, some have seen 90 per cent reduction in footfalls and are struggling to find working capital to provide salaries to their employees, said Bhushan. He said he hopes “private hospitals will keep their doors open”, and patients will seek timely treatment, otherwise “they will end up in complications”.
Also read: How well has Modi govt’s Covid strategy worked? Answer lies in 1 million+ tests done so far
‘Other treatments see a drop’
Dr Indu Bhushan also highlighted how all treatments under Ayushman Bharat – PMJAY have seen a fall in the last two months, revealing the impact on overall healthcare services in India.
Bhushan said the treatments provided under the scheme daily have more than halved amid the Covid-19 pandemic and the nationwide lockdown. “We were providing 25,000 to 30,000 treatments daily under PMJAY and that figure has come down to 10,000 to 12,000,” he said.
This is due to factors like lockdown, patients’ own fears of seeking care during this time, and the fact that many hospitals have become dedicated Covid-19 hospitals, he said.
From a monthly average of 7.4 lakh hospitalisations and healthcare procedures between August 2019 and February, the figure fell 57 per cent to 3.2 lakh in March. It further plunged 84 per cent to 53,000 in April, said the NHA data.
“Good thing is that for critical treatments like dialysis, chemotherapy, high risk deliveries, the numbers have not gone down significantly but only 10-15 per cent,” he said.
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PMJAY is a joke on the ppl of India. Even if u have a mobile connection, u r not entitled for the flagship scheme. What a bloody joke ! Feku has destroyed our country.