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, Ayushman Bharat – Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) is planned to cover 30 lakh souls in the state and equip them with Golden Cards, promising a health cover of Rs 5 lakh per family annually, on a floater basis.
The scheme was rolled out in December, but until now not even half of the beneficiaries have been identified, an official in the health and medical education department said.
He said only 12.2 lakh of the 30 lakh targeted 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 of poverty, but given the sluggish and sloppy enrollment the most deserving are being left out,” the official said.
While every family under the socio-economic caste census (SECC) database created in 2011 is entitled to the benefits under the scheme, health officials believe this census has left out thousands of families who otherwise qualify for it given their socio-economic conditions.
“There is a need to carry out fresh census or set some other criteria for inclusion under this scheme. The eight year old Census is messing it up,” a senior health official said, adding it would have been better if the Government had advertised about the scheme and its provisions, called for applications and constituted a team in every district to verify if the applicant deserved to be covered by PMJAY criteria.
Lack of awareness among the Golden Card holders was adding to woes of patients, a senior administrator working in an associated hospital of Government Medical College Srinagar said.
“In our hospital, we have had many instances where the patients, despite processing a golden card, had to shell out money for treatment because they did not produce the card before us prior to surgery,” the administrator said.
According to the scheme, Government is to appoint an Arogya Mitra to run a help-desk in every partner hospital to ease cashless treatment for beneficiaries, but no such appointment has been made so far.
As a result, another source said, in most hospitals the Ayushman Bharat desks are being run by a clerk, a paramedic or a nurse, in addition to their own responsibilities.
“The delay in allocating the manpower required to run the scheme could prove to be disastrous for it,” the source said.
Commissioner Secretary health and medical education, Atal Dulloo said that beneficiary enrollment was expected to increase as weather improved in Kashmir, adding that the government was addressing “initial hurdles”.
“PMJAY is our focus area and we are committed to making it a success in the state through innovative measures,” Dulloo said.