Nagaland availed INR 26 cr. under AB-PMJAY since its inception

Our Correspondent
Kohima, Sep. 23 (EMN): Minister for Health and Family Welfare S Pangnyu Phom on Thursday said that Nagaland has 2.33 lakh households, which translates to about 60% of the total population, covered under the Ayushman Bharat – Pradhan Mantri Jan Arogya Yojana (AB-PMJAY), which is touted to be the world’s largest public health insurance scheme.

He was addressing the third anniversary of Ayushman Bharat – Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) at The Deck, Hotel Vivor in Kohima.

‘Nagaland was among the first states to launch AB-PMJAY on September 23 in 2018,’ he informed.

He added that Nagaland was the first state to implement health benefit package 2.1 which includes organ transplant (kidney transplant) packages from this year onwards and that there were 1664 treatment procedures available under 26 specialities.

‘The scheme has immensely helped beneficiary families from Nagaland,’ the minister said, adding that about 20,000 hospitalisations and hospital claims worth INR 26 crore had been paid since the inception of the scheme.

“The numbers are dynamic, and with a somewhat stable pandemic situation, we have been seeing gradual increase in scheme uptake recently. Scheme uptake has been badly affected by Covid-19 pandemic,” he said.

It was also informed that e-card had been issued to 2.6 lakh individuals and had reached 96,000 households; which translates to 41% of the target families.

The minister asserted that the building and other construction workers registered under the department of Labour would soon join the scheme, and accordingly 8584 new families will be added in the state.

He pointed out that to ease the enrolment process and improve coverage in the state, ‘integration with National Food Security Act (NFSA) data is under process, whereby Aadhaar seeded ration cards will be linked to PMJAY portal’.

Further, it was informed that the Nagaland State Rural Livelihood Mission (NSRLM) will be partnering with State Health Agency PMJAY to spread awareness about the scheme through Self Health Groups (SHGs) and also enrolment and E-card generation through their block data operators.

Targets 70% coverage

Moreover, under the ‘Aapke Dwar Ayushman,’ a new initiative is also going to be held to carry out enrolment drives in the villages to increase e-card generation. The State Health Agency PMJAY along with various partner agencies will be carrying out these outreach drives till March 2022 with its target to reach at least 70% of the total target families, he informed.

He lauded the State Health Agency led by Principal Secretary Health and Family Welfare department, Amardeep Singh Bhatia, who is also the CEO of PMJAY, for successful implementation of the scheme in the state and also acknowledged the insurance company partners — Oriental Insurance Company Limited and the Paramount TPA — for their support in serving the people of Nagaland.

While wishing Ayushman Bharat Pakhwara and Ayushman Aapke Dwar initiative a success, the minister urged the community members to avail the scheme.

Meanwhile, Amardeep Singh Bhatia highlighted that Ayushman Bharat is a flagship programme of the Union Health Ministry.

He stated that the PMJAY aims to reduce out-of-pocket expenditure on medical care among the poor, deprived and vulnerable families so that they don’t experience catastrophic health expenditure and impoverishment.

PMJAY provides health insurance cover of INR 5 lakh per family per year, informed Bhatia, adding that families coming under deprived categories as per socio-economic and caste census 2011 can avail the benefit, while RSBY (older scheme prior to PMJAY) card holders, who have renewed their card in 2016 or 2017, are also eligible.

98 empanelled health facilities in state

It was informed that there were 98 hospitals and health centres implementing the scheme in the state — 84 public and 14 private hospitals. Beneficiaries can avail the benefit from any empanelled hospital across the country, he added.

Further, he stated that there are 1664 treatment procedures available and services are cashless and money should not be charged while availing the treatment.

Bhatia also maintained that there are challenges in scheme implementation, such as poor internet connectivity in rural areas, few secondary and tertiary care hospitals in most of the interior and peripheral districts and Covid-19 pandemic. In this regard, he said that internet connectivity is required for enrolment and generation of e-card and also availing treatment in hospitals through online portal.

He stated that automated triggers to detect suspected fraud, routine mandatory case audits, e-card audit, field investigations, and beneficiary call audits have been undertaken to detect fraud.

It was also informed that beneficiaries could file grievances through the CGRMS portal for denial of treatment by empanelled hospitals, charging of money for treatment while availing under the scheme etc.

Bhatia also stated that the PMJAY scheme showed promising signs as a model of delivering secondary and tertiary healthcare and pointed out that the current medical reimbursement system for government employees, or other socio-economic categories which are not covered by any medical insurance, could also come under the PMJAY platform.

41% households issued e-card

The officials of Health and Family Welfare led by the Joint Director and State Nodal Officer (SNO) of AB-PMJAY, Dr. Kika Longkumer, Dr. Sao Tunyi, Alongla Aier along with insurance partners representatives briefed journalists on the AB-PMJAY scheme.

During the briefing, it was informed that despite 2.33 lakh households covered in the state for AB-PMJAY, only 41% of the targeted households were reached with an e-card as on September 22.

The SNO of AB-PMJAY reiterated that the 41%, which could have been more, is due to the quality of ACC data, and stated that mismatch in entry of names on various documents led to difficulty in verifying the identity of persons. However, he exuded hope that with the partnership of the Food and Civil Supply department, a lot of data would be cleansed for the integration.

He informed that a total of 821 hospitalisations were availed from hospitals located outside the state while hospitals in the state had provided treatment for 239 hospitalisations for beneficiaries coming from other states.

It was stated that hospitals in Dimapur had the highest number of treatments and Christian Institute of Health Sciences and Research (CIHSR) was catering to a good number of patients followed by Kohima; public hospitals in Mon and Noklak were doing well in terms of providing treatments.

One fraud case registered

Besides the agency integrating with other departments to scale up enrolment, it was also revealed that ‘very soon, a person can login to the portal and register oneself with an Aadhaar card in order to democratise the enrolment process and a person can also check out the eligibility’.

It was informed that there was one case of fraud by a hospital which was addressed, however it was revealed there were cases of forgery and impersonation with regards to e-card and audits were done and solved on the same.

Further, the department urged the beneficiaries to be proactive and to intimate their grievances to the district grievance officer, hospital nodal officer, state officer or even on the portal if treatment is denied in any empanelled centre.