Delivery of Ayushman benefits picking up pace in J&K

Maitri Porecha New Delhi | Updated on December 11, 2019

Popular procedures under the Ayushman Bharat scheme in J&K are dialysis, gall bladder removal, cancer care, cardiac stenting, total hip replacement and treatment for kidney failure (file photo)   -  Nissar Ahmad

Even without internet and mobile connectivity, claims are being processed, albeit slowly

Utilisation of cashless health insurance under the Pradhan Mantri Jan Arogya Yojana (PM-JAY), popularly referred to as Ayushman Bharat, have slowly started picking up pace in the Kashmir valley, despite the ongoing internet shutdown .

According to data available with the National Health Authority (NHA), a total of 13,068 patients were treated under the scheme in the Union Territories of Jammu, Kashmir and Ladakh. Of these, 8,491 patients were treated in the larger Kashmir region; up to 4,330 patients were hospitalised in Jammu; and 85 were treated in Ladakh-based hospitals. Also, up to 162 patients went to hospitals in Pathankot, Amritsar, Chandigarh, Delhi and Rishikesh for treatment. Officials said that September onwards, the number of patients seeking care under the scheme slowly started increasing even in the absence of internet and mobile phone connectivity. There were 2,432 hospitalisations in September, and in October, up to 4,376 hospitalisations had occurred, an increase of 79 per cent.

After abrogation of Article 370, with mobile connections snapped and travel curbs imposed, patients seeking government-based healthcare insurance showed a sharp drop in August.

Just 847 individuals were hospitalised in Jammu & Kashmir in August, a drop of close to nine times from 7,391 hospitalisations in the preceding month of July. “Even though numbers in September and October are still lower than that prior to the abrogation of Art 370 in July, cases under Ayushman Bharat have started picking up pace,” a NHA official told BusinessLine.

“Hospitalisations under the scheme have slowly and steadily started increasing in J&K,” confirmed PM-JAY CEO Indu Bhushan.

In the Kashmir Valley, 26 hospitals administer the scheme and most are private-run. In Jammu, 48 hospitals implement the scheme. In August, some private hospitals in Kashmir, where th after-effects of the abrogation were felt more, complained to J&K State Health Authority (SHA) about the delay in payments and temporary discontinuation of the scheme due to hurdles in claims processing.

“Certain private hospitals had discussed issues such as delayed payments with the J&K State Health Authority in August, and eventually, the payments were released. Things are slowly getting back on track,” the official said.

Internet is still not functioning in public and private hospitals. “The doctors have to either courier documents of claims after speaking for pre-authorisation with the insurance company on phone or physically come and submit papers. All of this takes at least a week’s time,” said the official.

The NHA data further showed that up till November 18 for the month, 4,072 hospitalisations were recorded. In the week of November 18 to 25, a sudden spike of up to 5,500 hospitalisations were observed in a single week. Between November 26 and December 2, only 800 cases were recorded.

“The week-on-week data in this situation can be misleading, because some of these cases may have occurred in earlier months between August and October but their information is being uploaded now, because of a delay in processing claims,” the official explained.

Since the launch of the scheme in December last year, up to 45,249 claims worth ₹24.3 crore have been submitted, of which 38,368 claims worth ₹19.7 crore have been cleared, till date. Popular procedures under the scheme in J&K are dialysis, gall bladder removal, breathing disorders, kidney failure, cancer care, cardiac stenting, and total hip replacement.

“We are slowly getting back on the trajectory of processing 38 claims per week per lakh population in J&K,” said the official.

Published on December 11, 2019

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