Greenfield States, such as Bihar, need to be nursed on to their feet

Radhika Merwin BL Research Bureau | Updated on January 28, 2019

An Ayushman ward at IGIMS, Patna   -  pictures by Radhika Merwin

Over 90 per cent of hospitals empanelled in Bihar are public, equipped to treat only delivery and medical management cases


Wading through the packed and hustling crowd at the Indira Gandhi Institute of Medical Sciences (IGIMS) at Patna, Bihar, the separate ward set up for patients getting treated under Ayushman Bharat, suddenly looms in front of you. The ward appears a lot less noisy and organised, but is nonetheless buzzing with patients and doctors. As I walk into the ward, and quiz relatives and patients on Ayushman, it becomes evident that most of them are aware of the benefits of the scheme that offers a cover of ₹5 lakh per family.

It was word-of-mouth that led Sanjay (name changed) to IGIMS for the treatment of his father for lung cancer. The patient has been in the hospital for nearly three months now and has not paid anything out of his pocket for the treatment. “If not for this scheme, we would have been unable to treat my father, as we have no cash to pay for this long a treatment,” explains Sanjay.

Sanjay’s father and many others are getting treated at IGIMS that has a separate ward for Ayushman patients. The hospital, a public one, treats tertiary/critical illnesses. The other initiatives such as maintaining a separate pink file for Ayushman patients (to ensure they are not billed for medicines or other charges) and making periodic announcements across other wards to educate people about Ayushman have led to over 400 patients being registered in the hospital under the scheme.

But IGIMS aside, in Bihar, where over 90 per cent of the hospitals empanelled under Ayushman are public, it is still basic procedures such as delivery and medical management that form a chunk of the claims raised so far under the scheme. Of the 5,700-odd claims raised in Bihar, over 50 per cent pertain to normal delivery; caesarian delivery is the second most common claims in the State.

From inadequate resources, inefficient infrastructure to outdated database, challenges are aplenty in Bihar. A few officials though are trying to make the best of the limited resources in the State.


Limited resources

Barring the scale and size that Ayushman Bharat brings in, it is true that health insurance schemes in the country are not a new animal. The Rashtriya Swasthya Bima Yojana (RSBY) scheme that came into existence nearly nine years ago offered ₹30,000 health insurance coverage per family for secondary and tertiary hospitalisation.

Aside from this, many States have also been successfully running their own State health schemes — Gujarat, Tamil Nadu, Chhattisgarh, Maharashtra and Karnataka. While RSBY has been subsumed under Ayushman, most of the States have dovetailed existing health schemes with Ayushman.

The real challenge has been in greenfield States such as Bihar where there has been no health scheme in the past.

The chunk of the 600-odd hospitals empanelled under Ayushman in Bihar are public hospitals. For the 11 crore population in the State, the little over 5,700 claims so far under Ayushman is hardly heartening.

The massive scam in the State under the earlier RSBY scheme led by nexus between government officials, insurance company and private hospitals, has made the government wary.

Hence, taking baby steps in implementing Ayushman, it has been mostly public hospitals that have been empanelled so far. But given that treatment is mostly free or subsidised under public hospitals already, the true success of Ayushman will be in empanelling private hospitals better equipped for complex/tertiary care.

Lack of adequate manpower and support systems in the State has been a key stumbling block in implementing the scheme, despite the focussed efforts of senior officials to ramp up the scheme. Manoj Kumar, CEO of Bihar Swasthya Suraksha Samiti set up to implement Ayushman Bharat in the State, says that “lack of specialist doctors may be an issue. The other constraint is the inadequate number of Arogya Mitras.”

A Swasthya Suraksha Samiti office set up to implement Ayushman in Bihar   -  Radhika Merwin


Arogya Mitras are essentially the backbone of the Ayushman who provide support in beneficiary verification, authentication, query management, grievance redressal etc. “In most hospitals in Bihar, the existing staff is burdened with the additional task of Arogya Mitra which is a key issue,” adds Manoj Kumar.

The recent strike in the State by Accredited Social Health Activists (ASHA) workers has also been an issue. An ASHA is a local woman who acts as a link between her rural community and the public health system. In Bihar, ASHA workers are given incentive of ₹100 to bring in claims below ₹5,000 and ₹200 for above ₹5,000 under Ayushman.

(To be continued)

Published on January 28, 2019

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