Lok Sabha Question No. 4483 (UNSTARRED), answered on 2019-07-19
Subject: Rashtriya Aarogya Nidhi
Ministry: HEALTH AND FAMILY WELFARE
Asked by: Srinivas Kesineni

## GOVERNMENT OF INDIA MINISTRY OF HEALTH AND FAMILY WELFARE

## DEPARTMENT OF HEALTH AND FAMILY WELFARE

LOK SABHA UNSTARRED QUESTION NO. 4483 TO BE ANSWERED ON 19 TH JULY, 2019

## RASHTRIYA AAROGYA NI DHI

## 4483. SHRI SRINIVAS KESINENI:

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

- (a) whether the Government has launched Rashtriya Aarogya Nidhi Scheme for patients bel poverty line, if so, the details and the objectives of the scheme;
- (b) the number of diseases identified under the scheme for extending financial assistance;
- (c) whether the Government proposes to bring more diseases under the scheme, if so, the thereof; and
- (d) the total financial allocation made under the scheme and the funds utilised during each of the last three years?

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

(a) to (d): The Government is implementing Umbrella Scheme of Rashtriya Arogya Nidhi to provide  financial  assistan ce  to  poor  patients  belonging  to  families  living  blow  State/UT -wise threshold poverty line.  The scheme has following three components:

- I. Health  Minister's  Cancer  Patient  Fund -to  provide  financial  assistance  to  poor patients suffering from Cancer.
- II. Rashtri ya Arogya Nidhi -to provide financial assistance to poor patients suffering fr life threatening diseases other than Cancer.
- III. Rare Disease - to provide financial assistance to poor patients suffering from speci rare diseases.

The  diseases  identified  under  the  Umbrella  Scheme  of  Rashtriya    Arogya    Nidhi  are Annexure .    The  Technical  Committee  constituted  under  the  Scheme,  inter - alia,  advises  the Government in enlisting of diseases from time to time.

Allocati on  made  and  funds  released  under  the  scheme  during  the  last  three  years  is follows: -

## (In Rs. crore)

| Year     |   Allocation |   Release |
|----------|--------------|-----------|
| 2016- 17 |         22   |     22    |
| 2017- 18 |         30   |     30    |
| 2018- 19 |         54.5 |     51.75 |

## Illustrative list of categories of treatment for financial assistance under Umbrella Sch Rashtriya Arogya Nidhi

| 1.   | Cardiology & Cardiac Surgery :                                                                                                                          |
|------|---------------------------------------------------------------------------------------------------------------------------------------------------------|
| 1)   | Pacemakers including CRT/Biventricular pacemaker.                                                                                                       |
| 2)   | Automatic Implantable Cardioverter Defibrillator (AICD) and Combo devices.                                                                              |
| 3)   | Coronary Artery Disease including Diagnostic Cardiac Catheterization and Angiography.                                                                   |
| 4)   | Interventional procedure including Angioplasty, with or without Stents (Bare well as Drug Eluting S tents) Rota - ablation, Balloon Valvuloplasty.      |
| 5)   | ASD, VSD and PDA device closure.                                                                                                                        |
| 6)   | Peripheral Vascular Angioplasty including Carotid Angioplasty & Renal Surgery and Stent Grafting.                                                       |
| 7)   | Coil Embolization and Vascular plugs.                                                                                                                   |
| 8)   | Electrophysiological Studies (EPS) and Radio Frequency (RF) Ablation.                                                                                   |
| 9)   | Cardio vascular surgery for Congenital and Acquired conditions including C.A.B.G, Valve replacement etc.                                                |
| 10)  | Heart/Lung Transplantation.(ceiling cost may be upto CGHS rates)                                                                                        |
| 11)  | Intra Aortic Balloon Pump (IABP).                                                                                                                       |
| 12)  | Thrombolytic Therapy for Acute Myocardial Infarction, Pulmonary Prosthetic valve Thrombosis.                                                            |
| 13)  | IVC Filter                                                                                                                                              |
| 2.   | Cancer :                                                                                                                                                |
| 1)   | Radiation treatment of all kinds including Radio Therapy and Gama Knife Surgery/GRT/MRT/Brachytherapy.                                                  |
| 2)   | Anti - Cancer Chemotherapy with supportive medication including hormonal therapy.                                                                       |
| 3)   | Bone Marrow Transplantation -Allogenic& Autologous                                                                                                      |
| 4)   | Diagnostic Procedures -including PET scan.                                                                                                              |
| 5)   | Surgery for operable malignant tumours.                                                                                                                 |
| 3.   | Urology/Nephrology/Gastroenterology/G I Surgery:                                                                                                        |
| 1)   | Dialysis (Both Haemodialysis as well as Peritoneal)                                                                                                     |
| 2)   | Plasmalpheresis in ABO incompatible donors                                                                                                              |
| 3)   | Continuous RRT in Acute Renal failure                                                                                                                   |
| 4)   | Vascular access consumables (AV Grafts, Catheters including perm catheters)                                                                             |
| 5)   | Renal transplant - The ceiling cost may be upto CGHS rates.                                                                                             |
| 6)   | USG guided PCNL and USG guided SPC.                                                                                                                     |
| 7)   | Endoscopic surgical procedures in urology including CPE with TURBT,CPE with catheterization, CPE with clot evacuation.                                  |
| 8)   | Endoscopic surgical procedures i n GI surgery.                                                                                                          |
| 9)   | Acute GI emergencies like Acute Pancreatitis, GI bleeding, Cholangitis, Obstruction, Biliary stricture, Acute Fulminant Hepatitis, Hepatic Abscess etc. |
| 10)  | Liver Transplantation and Surgery for portal hypertension -the ceiling cost may be upto rates.                                                          |

## 4. Orthopedics :

- 1) Treatment of Traumatic & Pathological Fracture.*
- 2) Implants for joint replacement.**
- 3) Spinal fixation Implant.**

*Only Indigenous implants for use in Fracture and Poly Trauma will be permitted under the scheme.

**Justification for Non Indigenous Implants would be provided by the treating doctor.

## 5. Neurosurgery -Neurology :

- 1) Brain Tumours
- 2) Head injury
- 3) Intracranial aneurysms & aneurysms of week vessels.
- 4) Vascular Malformations of brain & spinal cord
- 5) Spinal Tumors
- 6) Degenerative /Demyelinating diseases of brain/spinal cord
- 7) Cerebrospinal Stroke
- 8) Status Epileptics
- 9) Movement Disorders
- 10) Neurological infections (Acute/chronic)
- 11) Traumatic Spinal Injury
- 12) Occlusive Vascular Dise ase of Brain
- 13) Guillain - barre syndrome
- 14) Myasthenia Gravis in Crisis (medical and surgical)
- 15) Acute PolymyositiswithVentilatory Failure
- 16) Acute or Chronic Autoimmune Diseases

## 6. Endocrinology :

- 1) Complications and sequel of diabetes which require one time treatment e.g. Amputation or Renal Transplant or Retinal detachment, Glaucoma etc..
- 2) GH deficiency
- 3) Adrenal insufficiency (Acute/Chronic)
- 4) Cushing's Disease
- 5) Endocrine surgery with post surgical treatment for one year.
- 6) Metabolic Bone Disease/Renal Tubula r Acidosis.

## 7. Mental Illness :

Any treatment requiring one time grant for mental disorders including

- 1) Organic Psychosis (acute/ chronic).
- 2) Functional psychosis including Schizophrenia, Bio - polar Disorders, delusional disorders and other acute
- 3) Severe OCD, Somatoform disorders.
- 4) Developmental  disorders  including  Autism  spectrum  disorders  and  Severe  behav disorders during childhood.
- 5) Psycho diagnostics, neuropsychological assessments,  IQ  assessment, blood tests li lithium  and  drug  level  of  carbamazepine,  valporate,  phenytoin  and  any  other medications.
- 6) CSF studies screening for substances abuse/toxicology.
7. polymorphic psychosis

## 8. Gynecology :

Uterine Artery Embolization for Post Partum Hemorrhage

## 9 . Rare Diseases :

## 1. Disorders  amenable  to  treatment  with  Hematopoietic  Stem  Cell  Transplantation (HSCT)

- i. Lysosomal  storage  disorders  in  early  stages  for  which  Enzyme  replacement  Therap (ERT) is presently not available (eg Metachromatic Leukodystrophy ,  Krabbe's  disease and severe form of Mucopolysaccharoidosis (MPS) type I within first 2 years of age.
- ii. Adrenoleukodystrophy (early stages), before the onset of hard neurological signs.
- iii. Immune deficiency disorders eg Severe Combined Immunodeficienc y (SCID), Chronic Granulomatous disease, Wiskot Aldrich Syndrome,etc
- iv. Osteopetrosis
- v. Fanconi Anemia
- vi. Others to be decided on case to case basis

## 2. Disorders amenable to organ transplantation

- (1). Liver Transplantation - Metabolic Liver diseases and other Inborn Errors of Metabolism (small molecule diseases)
- i. Tyrosinemia (failure to respond to nitisinone therapy or have documented evidence malignant changes in hepatic tissue)
- ii. Glycogen storage disorders (GSD) I , II  and IV due to poor metabolic control, multiple liver  adenomas,  or  high  risk  for  Hepatocellualr  carcinoma  or  evidence  of  substa cirrhosis or liver dysfunction or progressive liver failure,
- iii. MSUD (Maple Syrup Urine Disease),
- iv. Urea cycle d isorders,
- v. Organic acidemias,
- vi. Wilson's disease (Decompensated cirrhosis)
- vii. Bile acid synthetic defects (Decompensated cirrhosis)
- viii. CriglerNajjar Type 1,
- ix. Alpha 1 antitrypsin deficiency (Decompensated cirrhosis)
- x. Progressive familial Intrahepatic Cholestasis (PFIC)(Decompensated cirrhosis)
- xi. Others to be decided -case to case basis

## (2) Renal Transplantation -

- i. Fabry's disease,
- ii. Autosomal recessive Polycystic Kidney Disease (ARPKD),
- iii. Autosomal dominant Polycystic Kidney Disease (ADPKD)
- iv. Others on case to case basis
5. iii ) Patients  requiring  combined  liver  and  kidney  transplants - Rarely  Methyl  Malonic aciduria may require combined liver & Kidney transplant) etc

## 10.Miscell aneous :

Any life saving procedure / any other major illness/treatment/intervention not covered u the components of Umbrella Scheme of RAN and recommended  by the Technical Committee cou be considered for financial assistance.