Ayushman Bharat, the government of India’s health insurance scheme for the underprivileged has been found fraught with many loopholes in Jammu and Kashmir, resulting in low beneficiary enrollment and no cover for thousands of poor families missed out in the socio-economic census of 2011.
Launched in September last year, AyushmanBharat – Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) is planned to cover 30lakh souls in the state and equip them with Golden Cards, promising a healthcover of Rs 5 lakh per family annually, on a floater basis.
The scheme was rolled out in December, butuntil now not even half of the beneficiaries have been identified, an officialin the health and medical education department said.
He said only 12.2 lakh of the 30 lakhtargeted beneficiaries had been identified until last week.
“Much was expected of the PMJAY in J&K,where treatment costs continue to push many families into the vicious cycle ofpoverty, but given the sluggish and sloppy enrollment the most deserving arebeing left out,” the official said.
While every family under the socio-economiccaste census (SECC) database created in 2011 is entitled to the benefits underthe scheme, health officials believe this census has left out thousands offamilies who otherwise qualify for it given their socio-economic conditions.
“There is a need to carry out fresh censusor set some other criteria for inclusion under this scheme. The eight year oldCensus is messing it up,” a senior health official said, adding it would havebeen better if the Government had advertised about the scheme and itsprovisions, called for applications and constituted a team in every district toverify if the applicant deserved to be covered by PMJAY criteria.
Lack of awareness among the Golden Cardholders was adding to woes of patients, a senior administrator working in anassociated hospital of Government Medical College Srinagar said.
“In our hospital, we have had many instanceswhere the patients, despite processing a golden card, had to shell out moneyfor treatment because they did not produce the card before us prior tosurgery,” the administrator said.
According to the scheme, Government is toappoint an Arogya Mitra to run a help-desk in every partner hospital to easecashless treatment for beneficiaries, but no such appointment has been made sofar.
As a result, another source said, in mosthospitals the Ayushman Bharat desks are being run by a clerk, a paramedic or anurse, in addition to their own responsibilities.
“The delay in allocating the manpowerrequired to run the scheme could prove to be disastrous for it,” the sourcesaid.
Commissioner Secretary health and medicaleducation, Atal Dulloo said that beneficiary enrollment was expected toincrease as weather improved in Kashmir, adding that the government wasaddressing “initial hurdles”.
“PMJAY is our focus area and we arecommitted to making it a success in the state through innovative measures,”Dulloo said.