Lok Sabha Question No. 1009 (UNSTARRED), answered on 2019-11-22
Subject: Financial Assistance for Medical Treatment to Poor
Ministry: HEALTH AND FAMILY WELFARE
Asked by: Malook Nagar

## GOVERNMENT OF INDIA MINISTRY OF HEALTH AND FAMILY WELFARE DEPARTMENT OF HEALTH AND FAMILY WELFARE

## LOK SABHA UNSTARRED QUESTION NO. 1009 TO BE ANSWERED ON 22 ND NOVEMBER, 2019

## FINANCIAL ASSISTANCE FOR MEDICAL TREATMENT TO POOR

## 1009. SHRI MALOOK NAGAR:

Will the Minister of HEALTH AND FAMILY WELFARE be pleased to state:

- (a)  the  details  of  the  schemes  being implemented  by  the  Government  for providing  financial assistance for the medical treatment of the poor; and
- (b) the number of beneficiaries covered u nder the said schemes, scheme wis , State/UT - wise?

## ANSWER THE MINISTER OF STATE IN THE MINISTRY OF HEALTH AND FAMILY WELFARE (SHRI ASHWINI KUMAR CHOUBEY)

(a) & (b): Details  of  the  Financial  Assistance  to  poor  patients  being  provided  und Rashtriya Arogya Nidhi are at Annexure I.

The  Ayushman  Bharat  Pradhan  Mantri  Jan  Arogya  Yojana  (AB - PMJAY)  provides cashless hospitalization facilities of up to Rs 5.00 Lakhs per family per year to aroun crores families (approx. 50 crore individuals) belongin g to p or and vulnerable sections of the population. The salient feature of the scheme and the State/UT wise details of benefic covered are at Annexure II and Annexure III respectively.

Janani  Suraksha  Yojana  (JSY) was  launched  in  April  2005,  with  t he  objective  of reducing maternal and neonatal mortality by promoting institutional delivery among pregn women  by  providing  financial incentive  to  all  BPL/SC/ST  pregnant  women  delivering  in Government  health  facilities/accredited  private  institutions  in both  High  performing  State (HPS) and Low Performing State (LPS) regardless of age of mother and number of children.

Control

Under the National Disease Control Programmes like National AIDS Programme,  National  Viral  Hepatitis  Control  Program  etc.,  free  dr ugs  and  diagnostics  are provided to all in need including those from poor and vulnerable sections.

## Financial Assistance to poor patients under Rashtriya Arogya Nidhi

Financial  assistance  is  provided  to  poor  patients  belonging  to  families  living threshold poverty  line,  suffering from major life threatening diseases such as Cancer, k liver,  heart, Rare  Diseases under  Umbrella  Scheme  of  Rashtriya  Arogya  Nidhi and  Health Minister's  Discretionary  Grant  (HMDG) . While  financial  assistance  upto  a  maximum  of Rs.1,25,000/ - is  provided  under  HMDG  to  defray  a  part  of  the  treatment  cost,  the  maximum financial assistance provided under the Umbrella Scheme of RAN is Rs.15 lakhin each case . However, assistance under both the schemes is provided as one - time grant only.

2. The Umbrella Scheme of Rashtriya Arogya Nidhi has following three components: -
- i. Health  Minister's  Cancer  Patient  Fund  (HMCPF) -for  treatment  of  poor pat ients suffering from Cancer.
- iii. Rare  Diseases -for  treatment  of  poor  patients  suffering  from  specified  ra diseases.
- ii. Rashtriya Arogya Nidhi (RAN) -for treatment of poor patients suffering from life threatening diseases other than Cancer.
3. Financial assi tance under the Umbrella Scheme of RAN and HMDG is permissible only to those patients taking treatment in government hospitals. Those taking treatment in private hospitals  are  not  eligible  for  assistance  under  the  schemes. R - imbursement  of  expenditure already incurred on treatment is also not permissible under the schemes.
4. Under the Umbrella Scheme  of Rashtriya Arogya Nidhi and Health Minister's Discretionary  Grant,  funds  are  not  released  to  States/UTs. Financial  assistance under  the schemes is  rel ased  to  the  hospitals  where  eligible  patients rece ve  treatment,  based  on application by the patient and recommendation of the treating hospitals in the prescribed . Details of funds released and number of patients benefitted during 2018 - 19 is as u nder:
5. Guidelines  on  RAN/HMDG  schemes  are  available  at www.mohfw.nic.in >  Major Programmes > Poor Patients - Financial Support > RAN/HMDG .

| Year     | Scheme                                    |   Funds released (Rs. in crore) |   Number of beneficiaries |
|----------|-------------------------------------------|---------------------------------|---------------------------|
| 2018- 19 | Umbrella Scheme of Rashtriya Arogya Nidhi |                           57.39 |                      2853 |
| 2018- 19 | Health Minister's Discretionary Grant     |                            5    |                       515 |

## Salient features of Ayushman Bharat - Pradhan Mantri Jan Arogya Yojana

1. AB-PMJAY is a centrally sponsored scheme. It is entirely funded by Government and  the  funding  is  shared  between  Centre  and  State  governments  as  per  prevailing guidelines of Ministry of Finance.
2. PMJAY  provides  health  coverage  up  to  Rs.  5  lakh  per  family  per  year  for secondary  and  tertiary  hospitalization  to  around  10.74  crore  poor  and  vulnerable families (approx. 50 crore beneficiaries).
3. PMJAY  is  an  entitlement  based  scheme.  This  scheme  covers  poor  and vulnerable  families  based  on  deprivation  and  occupational  criteria  as  per  SECC database.
4. PMJAY provides cashless and paperless access to services for the beneficiary at the point of service in any (both public and private) empanelled hospitals across India. In  other  words,  a  beneficiary  from  one  State  can  avail  benefits  from  an  empanelled Hospital anywhere in the Country.
5. Under PMAJY, the States are free to choose the modalities for implementation. They  can  implement  the  scheme  through  insurance  company  or  directly  through  the Trust/ Society or mixed model.
6. There  is  no  restriction  on family  size,  ensuring  all  members  of  designated families specifically girl child and senior citizens get coverage.
7. A well-defined Complaint and Public Grievance Redressal Mechanism, has been put  in  place  through  which  complaints/  grievances  are  registered,  acknowledged, escalated for relevant action, resolved and monitored.
8. PMJAY has created a robust IT system for implementation and role of real time transaction data.
9. At  National  level,  National  Health  Authority  (NHA)  has  been  set  up  as  an attached office to Ministry of Health and Family Welfare to manage the implementation of the scheme.
10. The details of package, operational guidelines and key features are available at www. pmjay.gov.in

| Annexure-III State-wise details for beneficiary families covered under AB-PMJAY as on 20.11.2019 since   | Annexure-III State-wise details for beneficiary families covered under AB-PMJAY as on 20.11.2019 since   | Annexure-III State-wise details for beneficiary families covered under AB-PMJAY as on 20.11.2019 since   |
|----------------------------------------------------------------------------------------------------------|----------------------------------------------------------------------------------------------------------|----------------------------------------------------------------------------------------------------------|
| Sl. No.                                                                                                  | State                                                                                                    | inception. Beneficiary families covered (in lakhs)                                                       |
| 1                                                                                                        | Andaman And Nicobar Islands                                                                              | 0.21                                                                                                     |
| 2                                                                                                        | Andhra Pradesh                                                                                           | 144                                                                                                      |
| 3                                                                                                        | Arunachal Pradesh                                                                                        | 0.90                                                                                                     |
| 4                                                                                                        | Assam*                                                                                                   | 27                                                                                                       |
| 5                                                                                                        | Bihar                                                                                                    | 109                                                                                                      |
| 6                                                                                                        | Chandigarh                                                                                               | 0.70                                                                                                     |
| 7                                                                                                        | Chhattisgarh                                                                                             | 41.5                                                                                                     |
| 8                                                                                                        | Dadra And Nagar Haveli                                                                                   | 0.70                                                                                                     |
| 9                                                                                                        | Daman and Diu                                                                                            | 0.50                                                                                                     |
| 10                                                                                                       | Goa                                                                                                      | 0.40                                                                                                     |
| 11                                                                                                       | Gujarat                                                                                                  | 70.0                                                                                                     |
| 12                                                                                                       | Haryana                                                                                                  | 15.5                                                                                                     |
| 13                                                                                                       | Himachal Pradesh                                                                                         | 4.8                                                                                                      |
| 14                                                                                                       | UT of Jammu And Kashmir and UT of Ladakh                                                                 | 6.1                                                                                                      |
| 15                                                                                                       | Jharkhand                                                                                                | 57                                                                                                       |
| 16                                                                                                       | Karnataka*                                                                                               | 115                                                                                                      |
| 17                                                                                                       | Kerala                                                                                                   | 40.9                                                                                                     |
| 18                                                                                                       | Lakshadweep                                                                                              | 0.01                                                                                                     |
| 19                                                                                                       | Madhya Pradesh                                                                                           | 118                                                                                                      |
| 20                                                                                                       | Maharashtra                                                                                              | 83.6                                                                                                     |
| 21                                                                                                       | Manipur                                                                                                  | 2.8                                                                                                      |
| 22                                                                                                       | Meghalaya                                                                                                | 8.4                                                                                                      |
| 23                                                                                                       | Mizoram                                                                                                  | 1.95                                                                                                     |
| 24                                                                                                       | Nagaland                                                                                                 | 5.7                                                                                                      |
| 25                                                                                                       | Puducherry                                                                                               | 1                                                                                                        |
| 26                                                                                                       | Punjab                                                                                                   | 45.87                                                                                                    |
| 27                                                                                                       | Rajasthan                                                                                                | 59.7                                                                                                     |
| 28                                                                                                       | Sikkim                                                                                                   | 0.4                                                                                                      |
| 29                                                                                                       | Tamil Nadu*                                                                                              | 147                                                                                                      |
| 30                                                                                                       | Tripura                                                                                                  | 4.9                                                                                                      |
| 31                                                                                                       | Uttar Pradesh                                                                                            | 118                                                                                                      |
| 32                                                                                                       | Uttarakhand                                                                                              | 19.7                                                                                                     |
| 33                                                                                                       | West Bengal                                                                                              | 111.9                                                                                                    |