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Southern states make most use of Modi’s govt’s PMJAY health scheme, Tamil Nadu 1st, data shows

Kerala & Karnataka take second & third spots, says National Health Authority. Lakshadweep is at bottom when it comes to availing benefits of Pradhan Mantri Jan Arogya Yojana.

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New Delhi: Tamil Nadu leads the way in making maximum use of the Centre’s flagship healthcare programme, closely followed by its neighbours Kerala and Karnataka, thanks to the robust healthcare systems already in place in these states.

Popularly known as the Modicare scheme, the Ayushman Bharat-Pradhan Mantri Jan Arogya Yojana (PMJAY) is a national public health insurance fund that provides coverage to low income groups. It provides health cover of Rs 5 lakh annually to every eligible family.

One in every five claims made under the PMJAY is from Tamil Nadu. Of the three of the five southern states that made good utilisation of the scheme, only Karnataka is ruled by the Bharatiya Janata Party (BJP).

Out of the 3,67,39,198 claims made under PMJAY, 67,40,887 or about 18% are from Tamil Nadu alone, followed by Kerala (44,75,503) and Karnataka (34,66,884), according to the National Health Authority (NHA), in charge of the programme. While among the states, Sikkim (8,543) and Arunachal Pradesh (2,700), were at the bottom of the table, the least number of claims (245) came from the Union Territory of Lakshadweep.

System in Place

Tamil Nadu Principal Secretary, Health, P. Senthil Kumar said “an established system in the state, thanks to the Chief Minister’s Comprehensive Health Insurance Scheme that was launched in 2009, helped the state make full use of the Centre’s PMJAY scheme which is very similar”.

“We already had a panel of private and government hospitals. Our insurance partners have also been very good,” he added.

According to the Tamil Nadu health officials, the state scheme provided cashless hospitalisation for specific ailments and procedures with coverage up to Rs 5 lakh per family.

Union health ministry officials said states with existing schemes were better performers for “obvious reasons”. Karnataka had an Arogya Karnataka scheme running where specific procedures in empanelled hospitals were covered, while Kerala had the Karunya Arogya Suraksha Padhathi scheme. Gujarat, which is fourth in the list, also had a programme called the Mukhyamantri Amrutum.

ThePrint reached out to NHA CEO R. S. Sharma over phone and WhatsApp. This story will be updated when a response is received.

According to an official statement issued on the day of the launch of the Centre’s programme in September 2018, “The objectives of the Yojana are to reduce out of pocket hospitalisation expenses, fulfil unmet needs and improve access of identified families to quality inpatient care and day care surgeries.”

Also Read: Too rich for govt schemes, too poor to go private — prepaid health card targets ‘missing middle’

Most claims for dialysis 

Since its launch, 15,96,39,924 Ayushman Bharat cards have been issued. Of the claims made, 63.23 lakh or about 17 per cent claims were made for dialysis. This, despite the fact that since 2016, the Centre had been running a National Dialysis Programme to ease access to the expensive procedure. The national programme does not cover dialysis in the private sector.

The second most utilised procedure, thanks to the pandemic, is the Covid test for which 40,55,973 claims were made. NHA officials say that the cumulative numbers were high but these date back mostly to 2020-21 when the tests were much more expensive than they were now and beneficiaries needed to be covered to ensure that whoever needed the test could get it.

(Edited by R. Geethalakshmi)

Also Read: ‘Want states to own scheme too’ — Ayushman Bharat health cards to have both central & state logos


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