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When Naveen (name changed) from Bihar came to Jharkhand for his mother’s eye treatment, the surgery was done free of cost under Ayushman Bharat, as both States are on board to implement the scheme. But at a broader level, the picture is not so encouraging.
Of the 3.3 lakh admissions under the insurance scheme, there are just around 3,800 portable cases – beneficiaries going for treatment to other States, totalling ₹10 crore of the claims as of January 5.
Several hitches in portability under Ayushman need to be addressed for such cases to ramp up significantly.
Key issues
Portability is a key positive under Ayushman as many States lack internal capacities for sophisticated procedures. Hence, in such cases, there are a large number of people who would access services outside the State. While Ayushman allows people to get treated free of cost in any other State, there are certain technical issues that need to be addressed for this to happen seamlessly. One, the transaction management system (TMS) within a State is different from that outside the State. Integrating the State and national TMS has been an issue. The other issue is monitoring of portable claims.
Officials in Bihar explain that when a person from the State goes to another State for treatment, it becomes difficult to ensure the legitimacy of claims. Fraud in small procedures done outside the State is difficult to track.
In Bihar, there are about 388 portable cases (pre-authorisation claims), with a chunk of the admissions in NHCP (National Health Care Providers such as AIIMS) and Uttar Pradesh. In Jharkhand, there are just about 414 portable cases, with over half the procedures done in Bihar and Uttar Pradesh. In Chhattisgarh, only a little over 100 cases pertain to patients who have done treatments outside the State.
In some of the north-eastern States, the numbers are not too heartening, either. Manipur, for instance, has seen just four pre-authorisation claims for portable cases totalling about ₹17,500. Mizoram has four such cases, while Tripura has 11, and Nagaland has only two cases.
Odd border cases
Interestingly, Dadra and Nagar Haveli, with just four hospitals empanelled under Ayushman, have seen 54 portable cases from Maharashtra – that is, patients from Maharashtra getting treated in Dadra and Nagar Haveli. In Daman and Diu there are 58 portable cases from Gujarat.
“There are 11 cases from Gujarat, where people living in border areas, have gone to Dadra and Nagar Haveli for treatment. Mostly people living in the border area for whom Dadra Nagar Haveli or Daman Diu is closer avail treatment there,” explained Dinesh Arora, Deputy CEO, Ayushman Bharat.
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