In a bid to increase testing and treatment facilities for Covid-19 patients, the Ministry of Health & Family Welfare, through its April 4 circular, had made such services available under Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY), which covers about 53 crore beneficiaries.
While the testing and treatment of Covid-19 was already free in public facilities, the intention of the Centre to rope in private players was to make such services free, even through private labs and private hospitals for the poor.
This is critical as private hospitals in many states may be better equipped ― with the necessary isolation beds, ICU infrastructure, ventilators or respirator facilities ― to tackle Covid-19 cases.
But of the 20,000-odd empanelled hospitals (of which 9,000 are private hospitals) under Ayushman, only select hospitals will be available for treating Covid-19 cases. Each state has notified or is in the process of enlisting government and private hospitals that are Covid-19 designated hospitals. Given that in a pandemic situation, strict protocols for treatment need to be followed and not all hospitals can be exposed to the risk of the virus spread, it is only understandable that select hospitals can be designated to treat Covid-19 patients.
For instance, in Gujarat, while 1,004 private hospitals are empanelled under Ayushman, 127 private hospitals are treating Covid-19 patients, according to the National Health Mission, Government of Gujarat website. In Rajasthan, according to an April 6 circular put out by the state, about 27 private hospitals were Covid-19 designated (about 1,498 private hospitals are empanelled under Ayushman).
There are about 2,269 hospitals empanelled under Ayushman in Tamil Nadu, of which 1,170 are public hospitals and 1,099 private. According to a release put out by the Health & Family Welfare Department, Government of Tamil Nadu, in early April, 110 private hospitals and about 21 government hospitals were designated for treating Covid-19 patients across the state. But the number of Covid-19 hospitals has been scaled up since then. Currently, 169 private hospitals in Tamil Nadu are designated to treat Covid-19 patients, according to TS Selvavinayagam, additional director of Public Health and Preventive Medicine.
In Jharkhand, of the 470-odd private hospitals, two have been designated as Covid-19 hospitals. In Uttar Pradesh, the list of Covid-19-designated private hospitals is being finalised.
“There are two aspects under Ayushman ― one is the testing and the other is the treatment. Under testing (including in private labs), OPD patients are also covered, including those for whom the test result is negative. We have to decide on the rates for private labs and also on how to test the poor who are not covered under Ayushman. As far as treatment goes, we are in the process of deciding Covid-19-dedicated hospitals, based on capacities and infrastructure. There are other factors also that come into play. Once a hospital is declared Covid-19-dedicated, then other cases become very limited. There are strict inherent quarantine procedures to be followed,” said a senior official at Uttar Pradesh state health agency.
For Tamil Nadu that had been running the Chief Minister’s Comprehensive Health Insurance Scheme (CMCHIS) for over seven years before the Centre’s Ayushman Bharat was announced, integration with PMJAY was smooth. While about 77 lakh beneficiaries must be covered under Ayushman as per Socio-Economic Caste Census (SECC) data, the State is covering close to 1.47 crore families for up to ₹5 lakh under PMJAY-CMCHIS, as it considers beneficiaries under its earlier CMCHIS ― for people with annual income of less than ₹72,000.
According to TS Selvavinayagam, government hospitals in Tamil Nadu have sufficient capacity and high-end infrastructure to treat Covid-19 patients. “Testing in private facilities is also covered under PMJAY-CMCHIS and is free. There are 169 Covid-19-dedicated private hospitals currently.”
Under the state’s scheme, 17 per cent of insurance claim proceeds have to be invested back into government hospitals, which has helped improve infrastructure and equipment in the state’s government hospitals over the years.
Ayushman provides ₹5 lakh cover to deprived rural families and identified occupational categories of urban workers’ families, as per the latest SECC data.
The empanelled hospitals are paid based on specified package rates ― costs associated with the treatment, including pre and post hospitalisation expenses. The Centre has developed a list of about 1,391 packages and finalised their rates. But some amount of flexibility is given to states to tinker with package rates. Further, states that are already implementing their own health insurance/ assurance schemes, have been allowed to continue with their existing package rates.
Currently, various states are in the process of designing and seeking approval from National Health Authority (NHA) for Covid-19 packages to ensure smooth claim process in private hospitals.
“The package, aside from including the cost of treatment of Covid-19-related symptoms, will also have additional expenses of ICU bed charges, personal protective equipment (PPE), ventilators, etc. We have submitted the package to NHA for approval. Only when it is approved can it be fed into the national transaction management system (TMS) to ensure a smooth claims process in private hospitals,” says Prabhat Kumar (IAS), Executive Director, of Jharkhand State Arogya Society.
TMS captures in-patient data on admission, treatment, discharge, and hospital claims.