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Portability feature in PM’s health scheme benefits TN patients
The introduction of the Pradhan Mantri Jan Arogya Yojana (PMJAY) – that has been dovetailed with the Chief Minister’s Health Insurance Scheme (CMCHIS) – has helped patients from Tamil Nadu seek treatment in other States due to the national scheme’s portability feature.
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According to P Uma Maheshwari, who is heading the Tamil Nadu Health Systems Project (TNHSP), there was no such feature in the CMCHIS.
She said the Prime Minister’s scheme facilitates a huge flow of patients to other States for healthcare facilities and treatment.
“Our patients are being treated in empanelled hospitals under the scheme in other States, including Karnataka and Kerala. The Jawaharlal Institute of Postgraduate Medical Educationand Research (JIPMER) inPuducherry is one such hospital,” Uma Maheshwari said.
In another positive development post the launch of the PMJAY, the State government decided to increase the coverage of beneficiaries under the CMCHIS to Rs 5 lakh each year, up from the previously promised amount of Rs 2 lakh.
“This order was passed to ensure that the beneficiaries under both the CMCHIS and the PMJAY get equal coverage,” she added.
While both the schemes cover a total of around 1,400 diseases, there a few differences between them, said a government official.
However, it is not so much the diseases but the packagesthat count. While some diseases can be clubbed together, others are split.
Some diseases such as diarrhoea, dysentery, and other minor ailments that are treated at the Primary Health Care (PHC) level are not included under the CMCHIS.
“This is mostly because in our State, we give free treatment to all those who walk into government hospitals for treatment - irrespective of their financial background. However, the said diseases have been included under the PMJAY,” said the official.
On the other hand, high-end transplants such as that of the liver, kidney and heart, cochlear implant, bone marrow transplant, bariatric surgery and the like, have been covered under the CMCHIS and not the PMJAY.
“While the CMCHIS gives a cover of up to Rs 5 lakh per annum to each family, it also caters to high-end transplant procedures of up to Rs 25 lakh,” the official said.
Of the total 77,000 families covered under the PMJAY, the Institute of Child health and Children’s Hospital (ICH) in Egmore alone has treated 3,028 beneficiaries.
“Many children in our hospital with avariety of diseases have benefited from the PMJAY,” said Dr S Srinivasan, Head, Neo Natal Intensive Care Unit (NICU) at the ICH.
It may be noted that the State government on February 8 announced that a total of Rs 1,363 crore was being provided in the budget estimates (2019-20) towards payment of premium for this scheme.
Vital healthcare
- There are 800 empanelled hospitals under the Chief Minister’s Health Insurance Scheme (CMCHIS)
- 77,000 families are being covered under the Pradhan Mantri Jan Arogya Yojana (PMJAY) in Tamil Nadu
- 1.58 crore families are being covered under the CMCHIS
- The coverage under the CMCHIS has been increased to Rs 5 lakh a year since the launch of the PMJAY to ensure equal coverage to beneficiaries under both schemes
- The ICH in Egmore alone has had 3,028 beneficiaries since the inception of the scheme in September
- Since the launch of the PMJAY in Tamil Nadu, 10 lakh families that were not covered under the CMCHIS, have also been included under the combined plan
- Since its inception in 2011-12, 28.34 lakh beneficiaries have availed medical treatment valued at Rs 5,527 crore
- The govt had recently increased the coverage from Rs 2 lakh to Rs 5 lakh per family per annum
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