The out-of-pocket healthcare expenses incurred by different population segments often have a severe catastrophic impact—families are pushed into mountains of debt and severe poverty. For those without access to financial resources, it also means abandoning the quest for treatment, even if the illness is life-threatening. Especially, with chronic illnesses like cancer—Deenamma’s family from Andhra Pradesh was in a similar situation, when they learnt that she had cervical cancer. They were daily wage laborers earning an average of INR 10, 000 per month… they could barely make ends meet, leave alone afford chemotherapy.
According to WHO, in India the out-of-pocket expenses were estimated to account for 62% of total health expenditure (60.6 billion USD out of US$ 97.1 billion USD) in 2017. In such instances, government-funded schemes like Ayushman Bharat PM -JAY have provided financial relief to millions of vulnerable families.
A work-in-progress, the scheme is constantly being upgraded to include innovative technology to make its implementation more effective. In fact, NHA has now included the PM-JAY e-card in the Digi Locker facility. “We are a data-driven scheme—every detail is documented and analyzed. Whether it is policy design, beneficiary data, hospital network/empanelment, fraud control or COVID-19. All details/data are collected on a daily basis via multiple platforms that we have implemented.” said Dr. Vipul Aggarwal, Deputy CEO, National Health Authority (NHA) in an interview.
According to Government Data, 1.4 crore cashless treatments worth INR. 17, 535 crores across 24,653 (Public: Private = 54:46) empaneled hospitals have been approved under the scheme. Right now, the scheme is recording 14 hospital admissions per minute: verifying 13 beneficiaries per minute and empaneling on an average 8 hospitals per day. In total, this has resulted in savings of nearly Rs. 35,000 Cr. to the people till date. The scheme covers 1,592 procedures under various health benefit packages with defined rates.
Elaborating on how easy and simple it is to enrol under the scheme, Dr. Aggarwal said, “All one needs to do is call #14555 (toll-free) and check if their name is enlisted. If it is, then you can go to any CSC or empanelled hospitals and get the e-card. Post this, all transactions with regard to availing benefits are cashless and paperless. A major highlight of the scheme is the feature of ‘portability’, so the beneficiary of one state can avail treatment from any empanelled hospital in any other state, anytime.”
The scheme also includes testing and treatment for COVID 19. Over 7 lakh people have been screened and treated for COVID-19 under the scheme. Here Dr. Aggarwal said, “Along with ensuring free and wide-reaching treatment for COVID-19, we have been actively working on educating and treating non-COVID patients suffering from chronic illnesses. People having critical illnesses like cancer, chronic renal failure etc. also require continuous treatment, and for this purpose, we went for an aggressive hospital empanelment drive.”
COVID 19 has not only created health and economic havoc but has brought to light the several challenges in India’s healthcare system. This scheme has only completed 2 years and keeping in mind that a large portion of India’s population belongs to the vulnerable segment, we are yet to see how the scheme will benefit the citizens and what major changes it will drive.