Dr. A G Ahanger
For the region which has been at the epicentre of political turmoil, the performance under Ayushman Bharat Pradhan Mantri Jan Arogya Yojana(AB PM-JAY)is like a shining beacon of light at the end of a dark tunnel for the UTs of Jammu and Kashmir and Ladakh.The ambitious health assurance scheme was launched in erstwhile State of Jammu and Kashmir (J&K) on 1st Dec 2018providing comprehensive financial protection of 5 lakhs per family for 6.13 lakh families in Jammu and Kashmir (including Ladakh), ~30% of total families in the State, as per SECC.
No similar scheme had been implemented in Jammu & Kashmir prior to AB PM-JAY, thus its outstanding performance under the scheme came as a pleasant surprise for many. The impact of the scheme has been evidently so astounding and promising on the lives of the people of Jammu and Kashmir, in less than 2 years of implementation, that the Government of Jammu and Kashmir has decided to launch Jammu and Kashmir Health Scheme in convergence with AB PM-JAY, which will extend the coverage similar to AB PM-JAY to all residents of Jammu and Kashmir, including employees/pensioners of the Government of Jammu and Kashmir and their families.
Notwithstanding the difficult topography, the harsh climatic conditions in winter months and other issues in the Valley, the commitment shown by the administration coupled with the keen interest of the beneficiaries of the State, propelled Jammu & Kashmir’s success in implementation of the scheme with more than 10 lakh e-card issued within the first 90 days of the launch of the scheme. Jammu &Kashmir issued E-cards covering 57% of target families in less than 6 months of the launch, which set a precedent for e-card generation to be carried out in mission mode in many other States. It is noteworthy that despite the internet and mobile connectivity challenges across both the UTs, close to 81 percent of all e-cards issued are verified with Aadhaar in real time.
Effective participation of beneficiaries through door to door registrations supported by Common Service Centres and comprehensive awareness and outreach campaigns by the District functionarieshelped in gaining great momentum.231 hospitals (34 private) got empanelled under the scheme across both the UTs. As a direct correlation to these IEC activities, the implementation and the utilisation grew from strength to strength with85,689 hospital admissions worth approx. Rs. 48 crores(as on 25.07.2020) availed by beneficiaries of both UTs.This came as a huge relief against an annual average of Rs. 8,789 spent on every hospitalisation across the State of J&K with Rs. 5,714 and Rs. 43,098 at public and private hospitals, respectively (as per 75th NSSO).
The interest and utilisation by private hospitals has been extremely encouraging with about 65 percent of 85,689 treatments in the UT of J&K taking place at private hospitals, whereas traditionally public hospitals have been catering to more than 90 percent of all inpatient services in the region. This may help in strengthening penetration of private sector for inpatient services with higher demand in comparison to capacities at public hospitals. At the same time, claim money earned by the public hospitals will help them to further strengthen their infrastructure and services for the greater advantage of all citizens. Interestingly, about 60% of the utilisation amount of Rs. 48 crores for both the UTs has been spent on Public hospitals. District Hospital, Pulwama and Sher-i-Kashmir Institute of Medical Sciences (SKIMS), Srinagarare an exemplary illustration of the impact of efficient, effective, and innovative utilisation of the available resources on the overall services extended by any public hospital.
Portability of benefits is a unique feature of the scheme which empowers the beneficiaries to take treatment at any hospital empanelled under the scheme across the country. Availing this facility, about 864 treatments have been taken by beneficiaries at hospitals outside both the UTs at empanelled hospitals located at Delhi, Chandigarh, Punjab, Haryana and as far as Karnataka, among others.
Even in situation of no internet connectivity or other restrictions, the State Health Agency, Jammu and Kashmir – responsible for implementation of AB PM-JAY in UT of J&K with support from National Health Authority was able to innovate mechanisms for extending treatment to the beneficiaries without any disruption. The average daily admissions under AB PM-JAY in the first 100 days after enactment of The Jammu and Kashmir Reorganisation Act, 2019 were higher in the UT of J&K than the average daily admissions taking place before the Act was passed. This reflected the grit and determination of the people of Jammu and Kashmir when faced with adverse circumstances.
The implementation of the scheme has been almost symmetrical across the entire region, even in the south Kashmir region which is considered as the most disturbed area in the UT J&K on account of insurgency. The numerous heart-warming stories of beneficiaries from across the region whose lives have been touched by the scheme as a ray of hope in dire circumstances is a testimony of the scheme being wholeheartedly welcomed by almost all communities within the state.
Ray of hope
Misra Begum, a 57 year old lady from Zakura, Srinagar hails from a very poor family. Misra lost her husband a few years ago and now lives with her two sons. Her younger son is studying while the elder son is a casual labour and the sole bread earner of the family with a meagre monthly income. Misra was diagnosed with a heart ailment long time ago and was advised by doctors to undergo surgery, however, due to her poor financial status and high cost involved in the surgery she was not able to undergo the surgery as it was not possible for her family to afford the same.
After her neighbour informed her about the AB PM-JAY scheme; she came to know about the scheme and immediately along with her son went to the nearest empanelled hospital to inquire about the scheme and also about her eligibilty. Upon confirmation that she is eligible, the Pradhan Mantri Arogya Mitra verified her and issued her e-card immediately.
Post issuance of e-card, Misra was admitted in a reputed Private Hospital in Srinagar to undergo surgery for her heart ailment. The surgery was successfully performed on Misra by placing a Double Chamber Pace Maker. The total cost of the surgery and treatment borne by the Government under AB PM-JAY scheme was close to Rs. 65,000, something which Misra Begum and her family could not have been able to afford on their own.
Irrespective of the challenging topography and winter season in Ladakh, the performance of the scheme in the districts of Kargil and Leh, now part of UT of Ladakh, wasvery encouraging with 70% of all families being issued e-cards. 10 public hospitals are empanelled under the scheme in the UT of Ladakh and close to 750 hospital admissions worth about Rs. 65 lakhs have been availed by the beneficiaries of Ladakh (as on 25.07.2020). 30% of these treatments have taken place availing portability in J&K, Delhi, and Chandigarh. Intriguingly, the average treatment cost for beneficiaries of Ladakh is more than 150% of those of J&K, which hints at pent up demand for tertiary care services among beneficiaries of Ladakh. As bulk of the claim money is earned by the public hospitals in Ladakh, it is hoped that it provides necessary impetus for improvement in infrastructure and services.
Ayushman Bharat Pradhan Mantri Jan Arogya Yojana has entered the lives of the people of J&K and Ladakh and as a glimmer of promise, leading to provision of much required financial protection against health expenditure.
While the efforts of State Health Agency, Jammu and Kashmir have been appreciated widely and hailed as one of the better implementation models under AB PM-JAY, it can be said with certainty that the team will strive for the successful implementation of Jammu and Kashmir Health Scheme (in convergence with AB PM-JAY) with greater zeal and commitment.
(The author is Director SKIMS)
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