Hyderabad: Two years into the launch of Ayushman Bharat-Pradhan Mantri Jan Arogya Yojana (PMJAY), the countrywide universal health insurance scheme continues to pale in comparison to the scale of Telangana’s Aarogyasri Health Insurance Scheme that covers nearly 85 lakh families.
The recent efforts of Health Minister Eatala Rajender to further restructure the Aarogyasri insurance scheme, bring in reforms that includes ensuring medical bills are audited quickly and funds released and encouraging private hospitals to provide all their health care services, instead of just a few, promises to further improve the ease of access of health care to the beneficiaries.
“Aarogyasri is 100 times better and more efficient that Ayushman Bharat insurance scheme. We are providing coverage to 517 different medical conditions, which is not the case with any other insurance scheme in the country. Close to 434 treatments that are covered under Aarogyasri are very expensive and are not offered by any other public-run insurance scheme. Aarogyasri provides insurance for rare medical conditions like bone marrow transplant and even organ transplantation,” Rajender says.
The rates or cost of treating medical conditions under Aarogyasri is far higher than Ayushman Bharat, which has continued to struggle with limited network of empanelled hospitals for treatment. A large number of private hospitals that are enrolled in the PMJAY scheme also tend to insist on upfront payment, which is reimbursed to the patients only after the medical bills are cleared by Ayushman Bharat.
The national health insurance scheme also does not cover indirect costs that patients and their relatives suffer during the time of hospitalisation. In quite contrast, Aarogyasri also has innovative components like providing free food and transportation, free follow-up services and cashless treatment to patients.
Overall, the Aarogyasri health insurance scheme provides coverage to 949 different treatment modalities for patients. The scheme provides insurance coverage to each family from Rs. 2 lakh to Rs.13 lakh and in some specialised therapies, there is no capping to the cost of treatment.
Moreover, there are exclusive health insurance schemes for employees including ESI, Employee and Journalists Health Scheme (EHS/JHS), health insurance for Singareni employees through which the authorities are providing health coverage to another 20 lakh families, which amounts to nearly one crore families in the State.
In contrast, Ayushman Bharat envisages extending coverage to families with insurance coverage limit of Rs.5 lakh. Ayushman Bharat has based its beneficiary selection on Socio-Economic Caste Census (SECC) data in both urban and rural areas. In sharp contrast, Aarogyasri doesn’t consider or classify beneficiaries based on profession and broadly covers all families by just insisting on a white card.
“There is no denying the fact that Aarogyasri offers better rates or cost of treatment than Ayushman Bharat to empanelled hospitals. Anybody can check this fact by visiting the website of the PMJAY where the treatment tariffs are very less and private hospitals, especially small and mid-sized establishments can’t survive at that rate. We also believe that Aarogyasri scheme can be further improved by ensuring that the medical bills are processed and funds released quickly,” feels Dr T Hari Prakash, secretary, Telangana Aarogyasri Network Hospital Association (TANHA).
Along with Aarogyasri and employee health insurance, over the last few years, the State health authorities have also developed unique standalone health care initiatives including T-dialysis and T-diagnostics that have further strengthened healthcare services in Telangana.
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