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Ayushman Bharat: Ensuring advanced healthcare for poor
The scheme envisages bringing in as many as 10 crore families under its protective ambit – the number is so huge that it is bigger than the population of some of the smaller countries in the world.
By
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Chennai
Unexpected medical expenses can have a debilitating effect for a typical poor and even lower middleclass family that does not have the safety net of medical insurance. In a country like India, a large chunk of households does not have insurance, and hence there are too many cases of crippling financial crisis.
This was revealed by the 71st report of National Sample Survey Office (NSSO), that said 85.9 per cent of rural families and 82 per cent of urban families in India did not have medical insurance.
Due to this, the report added, nearly a quarter of families in the hinterlands and 18 per cent in urban areas are falling into the dreaded debt trap after incurring that heavy cost on account of
medical expenses.
Taking cognisance of the findings of the survey, the Narendra Modi-led Centre launched Ayushman Bharat Yojana on September 23 last, an ambitious scheme to provide medical insurance to the poor and downtrodden families in the country.
As per the plan, the Union Government would spend Rs 10,000 crore in the first two years to cover more than 10 crore families across the country.
This is one of the biggest such schemes in the world for which 16,134 government hospitals and 8,807 private hospitals have been registered.
Treatment for over 1,000 ailments
Under Ayushman Bharat Yojana, as many as 1,393 ailments will be covered, to treat which, each insured family can avail treatment worth Rs 5 lakh. Moving beyond the restrictions that are part of similar schemes run by the State government, this Central scheme would allow people to avail treatment from any of the empanelled hospitals in any State.
It covers families of homeless, roadside dwellers, rag pickers, domestic workers, unorganised sector workers, members of SC/ST communities, persons with disabilities and families depend on women, with 11 conditions.
In all, 30 States, including Tamil Nadu, and Union Territories have already signed the agreement with the Centre in this regard. The only significant opposition came from West Bengal that had 1,240 registered hospitals, which opted out of the scheme.
The move would have an effect on not only those from the State but also patients from neighbouring states such as Bihar, Jharkhand and Chhattisgarh, who visit the registered hospitals in the West Bengal.
So far, around 10.74 crore families have been given medical coverage under the Ayushman Bharat Yojana.
State and Central scheme merged
Tamil Nadu has had a government-funded insurance scheme – Kalaignar Insurance Scheme – that was launched in 2009 by the then Chief Minister M Karunanidhi to provide high-end treatment for 51 ailments involving expenses up to Rs 1 lakh.
When J Jayalalithaa succeeded him, it was expanded and renamed as ‘Chief Minister’s Comprehensive Health Insurance Scheme’. Under this, more than 1.47 crore families with an annual income of less than Rs 72,000 were benefited.
There are some differences between the schemes run by the State and Centre. For instance, the Chief Minister’s Comprehensive Health Insurance Scheme does not provide cover for dental treatments, which is, however, covered under Ayushman Bharat Yojana.
Despite criticisms, the State and Central schemes have been merged after several rounds of discussions. In Tamil Nadu, nearly 77 lakh persons are eligible for availing insurance under Ayushman Bharat Yojana.
For each family, Tamil Nadu will pay an annual premium of Rs 699. Under the agreement, the Centre would pay 60 per cent of the premium, while the State would foot the rest. Tamil Nadu has been seeking Rs 360 crore per year from the Centre to implement the scheme.
Even though the treatment bill has been capped at Rs 5 lakh under the State scheme, the government would provide more than Rs 20 lakh for eight diseases including heart disorders, cancer, liver ailments, kidney dialysis and bone-related diseases.
Number of beneficiaries under Ayushman Bharat
Sept25,407
Oct1,44,924
Nov3,86,924
Dec6,85,807
- In Tamil Nadu, nearly 77 lakh persons are eligible for availing insurance under Ayushman Bharat Yojana. For each family, Tamil Nadu will pay an annual premium of Rs 699
- Any doubts or issues on Ayushman Bharat Yojana can be clarified by calling toll free number 1800 4253 993. The number functions round the clock
- When a patient visits a hospital that has been linked with the Ayushman Bharat Yojana, the personnel at the hospital can check the eligibility status of the patient using an exclusive portal created for the scheme. If eligible, he/she will be treated under the scheme and the government will pay the hospital online
- Senior State government officials claim that they are implementing Ayushman Bharat Yojana with the State government’s fund
- Renowned philanthropist and Microsoft founder Bill Gates had praised Prime Minister Narendra Modi in a tweet for implementing the Ayushman Bharat Yojana
- Nearly 1.47 crore families have been insured under the Chief Minister’s Comprehensive Health Insurance Scheme in the state and nearly 77 lakh families have been identified to benefit under Ayushman Bharat Yojana. As the two schemes were linked, the beneficiaries can avail a benefit up to Rs 5 lakh
- The Central government had allocated Rs 6,400 crore for Ayushman Bharat Yojana in its interim budget announced in February
- Even though the Central government is entailed to release Rs 360 crore to the State government to implement the insurance scheme, the Central government had only released Rs 86 crore - Rs 75 crore for paying premium and Rs 11 crore for administrative expenditures
No. of hospitals registered under the scheme in TN
(As on February 9)
Ariyalur: 12
Chennai: 346
Coimbatore: 141
Cuddalore: 35
Dharmapuri: 41
Dindigul: 62
Erode: 73
Kancheepuram: 101
Kanniyakumari: 97
Karur: 33
Krishnagiri: 29
Madurai: 134
Nagapattinam: 34
Namakkal: 47
Perambalur: 14
Pudukkottai: 53
Ramanathapuram: 28
Salem: 102
Sivaganga: 42
Thanjavur: 85
Theni: 57
The Nilgiris: 18
Tiruvallur: 48
Tiruvarur: 36
Tiruchy: 111
Tirunelveli: 82
Tirupur: 43
Tiruvannamalai: 31
Thoothukudi: 57
Vellore: 74
Villupuram: 60
Virudhunagar: 53
Total: 2,179
Over 1 lakh persons benefited in the State, says TN official
Dr T S Selvavinayagam, Additional Director of Chief Minister’s Comprehensive Health Insurance Scheme, explains the scheme saying Rs 5 lakh will be provided by the government each year.
Which persons are eligible to benefit from Ayushman Bharat Yojana?
All the citizens whose names are included in the socio-economic survey conducted in 2011 can benefit
under the scheme
Will a citizen’s lack of a family and Aadhaar card prevent him/her from availing the scheme?
Persons who have been enrolled in the Chief Minister’s Comprehensive Health Insurance Scheme can benefit under the Ayushman Bharat Yojana scheme. Arrangements will be made to help the patients who are eligible for the scheme but lack medical insurance
What are the differences between State and Central insurance schemes?
There is no difference between the schemes. Treatment cans be availed under both the schemes if the patients have the insurance card issued by the government. The schemes have been linked the schemes to help patients benefit from both the State and Centre
How many patients were benefited in Tamil Nadu? Which TN district has the highest number of beneficiaries?
As many as 1,09,445 patients have benefited in the state and an amount of Rs 258.8 crore has been spent on the treatments. Chennai has the highest number of beneficiaries
What are the common ailments that Ayushman Bharat Yojana is used for by patients?
The insurance is availed mainly for heart-related disorders, cancer and dialysis
Does the scheme cover post-hospitalisation medical expenses?
Rs 5 lakh will be available for treatment every year
Which disease in particular has the government released the largest funds?
Heart-related diseases
Do patients prefer government or private hospitals for availing treatment using the scheme?
Nearly 65 per cent of patients go to private hospitals while 35 per cent visit government hospitals
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