‘On average, daily claim outgo is about Rs 2 crore now’
Jammu: The Jammu and Kashmir government on Tuesday said that over 7 lakh treatment amounting to more than Rs 1100 crore have been provided to the domiciles of the Union Territory under Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB PM-JAY) and AB PM-JAY SEHAT, saying that on an average, the daily claims outgo is about Rs two crore now.
As part of its efforts to improve services rendered under the AB PM-JAY/ AB PM-JAY SEHAT scheme, Health & Medical Education department, through its 104 Call Centre, contacted 21,145 beneficiaries during the last six months out of the which 58% rated the services provided under AB PM-JAY/ SEHAT as excellent, 41 % rated the services as good and 1% rated the services as poor.
On the basis of the feedback of the beneficiaries, grievances received on CGRMS, CPGRAMS, JKIGRMS, feedback of Insurance Company and triggers received from National Anti-Fraud Unit (NAFU) of National Health Authority (NHA) and strictly as per the guidelines issued by NHA, State Health Agency (SHA) conducted audit of 100 % claims preferred by Empanelled Private Hospitals including highly utilized packages like Cholecystectomy (Removal of Gall Bladder). So far more than 60,000 cases have been audited during the current policy period. This is in addition to the audit of each claim being done by the Insurance Company. This ensures efficient claim scrutiny which prevents unnecessary procedures from being booked under the scheme. On the basis of the audit, SHA imposed Rs. 3.06 Crores as penalty on the erring empanelled health-care providers and have taken action under guidelines against erring hospitals and treating doctors for violating standard treatment guidelines or for any other malpractice.
Government of Jammu & Kashmir under Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB PM-JAY) and AB PM-JAY SEHAT empowers every family of J&K with a financial protection of Rs 5 lakh annually for meeting health expenditure. Jammu & Kashmir was one of the first States/UTs to universalize AB PM-JAY. The scheme is being implemented in the Insurance mode. So far, under AB PM-JAY and AB PM-JAY SEHAT more than 7 Lakh treatments have been provided to J&K domiciles including treatments received outside J&K using portability option and the treatments amount to more than Rs. 1100 Crores. On an average the daily claim outgo is about Rs. 2 Crores now.
Every 10 in-patients are facilitated by a Pradhan Mantri Arogya Mitra (PMAM) across all the empanelled health-care facilities of the Union Territory and there are about 425 such PMAMs working in Public Health-care facilities. Besides PMAM, Medical Coordinators have also been designated for each empanelled hospital for smooth processing of the case after admission of the beneficiary in the hospital.
Under the scheme, 2295 procedures are covered out of which some procedures are exclusively reserved for public hospitals like psychiatric & maternity procedures including Hysterectomy (Uterus removal) etc.
Further, capacity building programs are being conducted by NHA & SHA wherein PMAMs, District Implementation Units (DIUs) and other stakeholders are being regularly trained. Regular IEC activities are being undertaken by SHA for educating and informing the public about different aspects of the scheme.
There is a dedicated National & UT level helpline for the beneficiaries and beneficiaries are being facilitated throughout the process of treatment. General Public or prospective beneficiary patients are requested to contact SHA in case of any grievance through 104 Call Centre, QR Code Scan (available at Ayushman kiosk at all the EHCPs), Helpline No: 18002335554, 18002034138, Whatsapp Helpline No: 9906241592. Further, General Public is advised not to pay heed to any misinformation about the scheme. Any spread of misinformation shall be dealt with strictly.