Ayushman Bharat: Boon for poor, but discrepancies play spoilsport

Aparna Banerji

Tribune News Service

Jalandhar, January 22

The Ayushman Bharat Sarbat Sehat Bima Yojana (AB-SSBY) launched on August 20, 2019 opened up benefits of free healthcare for BPL families, farmers, journalists, small traders and requisite card holders. The scheme has acted as a boon for lakhs of beneficiaries burdened by unaffordable healthcare. However, discrepancies and persistent denial of services to beneficiaries has given way to serious anomalies.

With 54.57 per cent coverage, Jalandhar ranked 13th in the state in terms of the coverage of the scheme. Of 2,62,609 families, the scheme has so far covered as many as 1,43,316 families and 2,92,562 individual e-cards had been generated in the district.

Treatment for beneficiaries

• Cashless treatment up to Rs 5 lakh per family every year.
• Cashless tertiary care treatment under 1,579 packages to beneficiaries, including 180 packages reserved for public hospitals of which 25 packages referable to private hospitals.
• The Covid-19 treatment at the empaneled hospitals as per the order of the government.

So far, claims of 48,086 beneficiaries had been submitted in the district and a total of Rs 62 crore and 15,59,056 has been released for treatment. In total, claims of 4,521 beneficiaries were rejected.

Within less than two years of the scheme, at least three hospitals had been de-empanelled in the district after discrepancies were found against them and several others had been issued notices after they were found overcharging.

As per a response to an RTI query filed by a Jalandhar- based activist and journalist Kumar Amit, 129 complaints had been made regarding the Ayushman Bharat Scheme on the 104 helpline in the district. Of these 129 complaints, 126 were hospital related and three were regarding common service centres. The district ranks second in the state with respect to complaints made regarding the scheme. It stands at third position with respect to complaints made against hospitals not entertaining card holders.

Dr Jyoti, Deputy Medical Commissioner-cum-Nodal Officer, Ayushman Bharat Scheme, said, “Thirteen public and 57 private hospitals have been empanelled under the scheme in Jalandhar district. We have 54.57 per cent coverage. We have recently started holding camps to enlist more beneficiaries on priority basis. Vidal Health Insurance has been roped in to increase the number of enrolment camps. At present, manpower is not sufficient. Constant efforts are being made to increase the reach of the scheme.”

The Deputy Medical Commissioner said, “We are reaching out to various departments to increase beneficiaries. The ASHA and ANM workers are taking lists from depot holders. We are also targeting common service centres and have requested all the departments to send lists of beneficiaries.”

Dr Jyoti said, “The District Grievances Officer formally solves the issues and in case he/she fails then they come to me. If issues still remain unaddressed then we take up them in the District Greivances Committee meeting.”

The Nodal Officer informed that the empanelled hospitals, which had been de-empaneled in the district, include Kapoor Hospital, Balaji Hospital and Rattan Hospital. Show-cause notices have been issued to two more empanelled hospitals regarding discrepancies in the scheme.

Know more about AB-SSBY

The AB-SSBY, a flagship health insurance scheme aims to provide financial protection to 75 per cent of the population of the state. It is entitlement-based cashless health insurance cover of Rs 5 lakh per family per year. Under this scheme, cashless and paperless treatment is available at the government and empanelled private hospitals.

Who all are eligible

NFSA ration card holders, J-form holder farmers, construction workers, Yellow card holder journalists, small traders and SECC (beneficiaries identified based on Socio Economic Caste Census of 2011 by the Government of India).

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