Bridging the Gap: Empowering the Underprivileged through SEHAT Scheme

The Pradhan Mantri Jan Arogya Yojana (PMJAY) SEHAT Scheme, a visionary initiative by the government, aims to provide healthcare coverage to the entire population of J&K, offering a health cover of Rs 5 lakh to each family.

Lauded as the first and perhaps the only insurance scheme of its kind, the SEHAT Scheme holds immense potential in mitigating the burden of catastrophic treatment costs for countless health conditions.

However, despite its noble intentions, the scheme falls short in providing comprehensive support for patients with life-consuming diseases, particularly cancer.

Many underprivileged and poor individuals, who were the intended beneficiaries of this program, face impoverishing health expenses due to gaps in its coverage.

The Current Limitations

While the SEHAT Scheme offers a substantial health insurance cover, it has certain limitations that adversely affect patients with chronic and life-consuming illnesses like cancer.

The SEHAT Scheme does not cover costs incurred by patients on an outpatient basis, stand-alone diagnostics, and drugs prescribed while not admitted to a hospital.

These exclusions are particularly burdensome for patients who require long-term treatment for life-consuming diseases. For instance, cancer patients often need continuous monitoring, follow-up consultations, and prescription medications, all of which are not covered under the scheme.

Same stands true for patients with cardiovascular diseases, Kidney diseases and many more. This financial burden poses a significant threat to their overall well-being and quality of life.

Another drawback is the capped number of chemotherapy packages under the Transactions Management System (TMS). This restriction leaves cancer patients struggling to access necessary treatment, hindering their chances of survival and recovery.

Disparities between Government Employees and the Masses

In 2021, the government allowed reimbursement of costs not covered under the SEHAT scheme for government employees. While this step was appreciable, it leaves a glaring disparity for the poor and underprivileged masses—the very individuals whom the SEHAT Scheme was designed to support. As government employees receive reimbursement for uncovered expenses, the marginalized population, who cannot afford out-of-pocket health costs, face the risk of being pushed further into poverty due to their health emergencies.

Advocating for Comprehensive Support

It is vital to recognize and appreciate the SEHAT Scheme's commendable initiative in extending health coverage to the entire population. However, we must also acknowledge the pressing need for reform to ensure that the underprivileged receive the support and cover they need to safeguard their health and financial stability. The SEHAT Scheme must consider the financial burden borne by patients with life-consuming diseases, such as cancer. Expanding coverage to include outpatient expenses, diagnostics, and prescription drugs will provide much-needed relief to those in long-term treatment.

Removal of Capping on Chemotherapy Packages: To improve the quality of cancer care, the scheme should remove the cap on chemotherapy packages, allowing oncologists to tailor treatments according to individual patient needs and treatment response.

Targeted Support for the Underprivileged: Many employees, Government and those with other insurance covers enjoy reimbursement benefits, and the same level of consideration should be extended to the less privileged. Special provisions for financial assistance must be implemented to ensure that no one is left behind due to financial constraints during their healthcare journey. Engaging in consultation with healthcare providers and experts can aid in identifying gaps in the current scheme. By addressing these issues, we can create a more robust and inclusive healthcare system.

By removing the capping on chemotherapy packages, expanding coverage to include outpatient expenses and prescription drugs, and offering targeted support to the vulnerable, Government can ensure that the SEHAT Scheme becomes a beacon of hope for those in dire need, safeguarding their health and financial stability in the face of adversity.