"Will Rope in Private Hospitals if Cases Surge"

The Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY), the flagship health insurance scheme of the Central government, has just reached the one-crore treatment landmark. The total cost has been around Rs 14,000 crore so far. Launched 20 months ago, the scheme - a partnership between Centre and states - provides Rs 5 lakh a year health cover to 10.74 crore poor families. Dr Indu Bhushan, CEO, National Health Authority, which implements the AB-PMJAY, talks to Joe C. Mathew about how the AB-PMJAY cover can help the poor fight the Covid-19 emergency. Edited excerpts.

Private hospitals are complaining that their footfalls have fallen considerably during the lockdown. What has been the experience of PMJAY-empanelled hospitals?

In the last two months, or after March 23, we have seen a significant drop in admissions. Before March 23, we were doing 25,000-30,000 hospital admissions/treatments per day, but after the lockdown, we are down to 12,000-13,000. This is more than a 50 per cent drop. The drop has been more in some states as compared to others. We have also seen that the drop has been more in private sector hospitals rather than public sector hospitals.

Why So?

We are looking at the reasons. The fear factor is one obvious reason. People don't want to go to hospitals for elective procedures as they are afraid they may get infected. Also, because of lockdown, mobility is restricted. The third reason is that many hospitals, including government ones, have become Covid-only (no admissions for other treatments), and in many private hospitals, footfalls have fallen so much that they have scaled down operations. It's a vicious circle. Some have closed OPDs, because of which footfalls have fallen further. So, there are three reasons - fear factor, mobility, and fall in supply.

Has it impacted all treatment packages under the PM-JAY?

Not all. In some critical packages like chemotherapy, dialysis, which cannot be postponed, we have seen a decline of 15-20 per cent, not 50 per cent. It is good news.

How can we address the problem?

We have embarked on a drive to have more hospitals on board, for both Covid and non-Covid treatments. Most importantly, we need more hospitals for non-Covid patients as number of Covid patients is not much compared to people who need chemotherapy or dialysis or surgery. Since April 1, we have empanelled more than 1,000 hospitals. Now, we have close to 22,000 hospitals. We have also launched an express way to empanel hospitals. Even hospitals that do not fully comply with our eligibility criteria are being taken on board temporarily, for three months, to improve quality and access to services.

On one side, you are de-empanelling hospitals that are not up to the standards, and on the other, adding more hospitals. Is this creating more problems?

We have been de-empanelling hospitals based on fraud and abuse. We are still maintaining zero tolerance of fraud and abuse. The relaxation is on other parameters. For instance, we have criteria for minimum number of beds, infrastructure, space, etc. These are parameters than can be waived off.

When the AB-PMJAY completed one year, you had over 18,000 empanelled hospitals. In the next eight months, you have added only 4,000, of which 1,000 were added in less than two months. Is this fast enough?

The 18,000 empanelled hospitals at that time included over 1,000 hospitals from West Bengal. Those have been taken out after they (West Bengal) withdrew (from PM-JAY). But frankly, 4,000 additional hospitals is not a small number because these are mostly private hospitals.

Are these from smaller towns? How many more such hospitals can you tap?

They are mostly from Tier-II and Tier-III towns. We believe that by the end of this year (2020), we should have around 25,000 hospitals.

How are you reaching out to new hospitals?

We have asked our state agencies to expeditiously dispose pending applications and send mailers to hospitals to get empanelled. We have a hospital empanelment module (HEM). It is paperless. They have to apply online. We have launched a module - HEM Lite - which requires lesser information, so that even if hospitals do not have all certificates, they do not take too much time to furnish the information. We have shortened the process. Earlier, there was a district-level empanelment committee where the DC or the Collector first gave his or her approval. Then, at the state level, the state empanelment committee approved it. Now we have delegated powers to one person. All this is being done to expedite empanelment of hospitals.

Your focus is primarily tertiary care. Are all these tertiary care hospitals?

We largely focus on tertiary care. But we also take some secondary care. The hospitals will be a mix of both. For Covid treatment, we need hospitals which are 100 per cent dedicated to Covid. It should not be a part-Covid facility because of fear of cross-infection. Though most hospitals providing Covid treatment are government hospitals, now we have empanelled some private hospitals.

The number of treatments seems to have more than doubled in eight months. But the number of e-card holders is still a fraction of the beneficiary universe. How do you see this growth?

Not everyone is interested in e-cards and e-card is not essential before coming for treatment. E-card only helps you know beforehand that you are eligible for the services. So, we are undertaking a drive to provide e-cards. Because of the lockdown, we have reduced emphasis on e-cards. If and when the situation improves, we will start it again.

Active Covid cases may not be huge but are steadily increasing. Do you foresee an emergency situation in the coming weeks and is this drive based on any such advance planning?

Right now, much of the load, 90 per cent and more, is being taken by government (hospitals). But if there is a huge surge, then, of course, these hospitals will not be enough. In that case, we will be looking to private hospitals as dedicated Covid hospitals. The Ayushman Bharat PMJAY is going to help. We have now established packages in most states. The remaining states should also be finalised soon, so that, we proceed with private hospitals providing Covid care as well.

At the moment, how many patients have come through this route?

Very few, as in government, it is free for everyone, whether they are Ayushman Bharat beneficiaries or not. We have done about 300 Covid treatments, mostly in private hospitals, till now.

@joecmathew