Lok Sabha Question No. 2294 (UNSTARRED), answered on 2022-07-29
Subject: Treatment of Ayushman Cards Holders
Ministry: HEALTH AND FAMILY WELFARE
Asked by: Kalaben Mohanbhai Delkar

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

LOK SABHA UNSTARRED QUESTION NO. 2294 TO BE ANSWERED ON 29 TH  JULY, 2022

## TREATMENT OF AYUSHMAN CARDS HOLDERS

## 2294.  SHRIMATI DELKAR KALABEN MOHANBHAI:

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

- (a)  whether proper and adequate treatment is not being provided to the Ayushman Card holders in  Government  hospitals  and  they  are  devoid  of  treatment/  health  facilities  in  empanelled private hospitals under the said scheme;
- (b)  if so, the details thereof along with the reasons therefor;
- (c)  whether such a situation is compromising the basic objective of the said scheme, if so, the details thereof; and
- (d)  the  immediate  steps  taken  to  solve  the  complaints  in  this  regard  and  to  make  the  Scheme successful?

## THE MINISTER OF STATE IN THE MINISTRY OF HEALTH AND

## ANSWER FAMILY WELFARE (DR. BHARATI PRAVIN PAWAR)

(a) to (d): As of 27 th July 2022, approximately 3.65 crore hospital admissions worth over Rs. 43,140 crore are authorized under Ayushman Bharat  - Pradhan Mantri Jan Arogya Yojana (AB-PMJAY)  through  a  network  of  24,834  empanelled  healthcare  providers  (public  and private).

As per the terms and conditions of empanelment, hospitals cannot deny treatment to genuine beneficiaries  of  the  scheme.  In  case  of  denial  of  treatment  by  the  empanelled  hospital, beneficiaries  can  lodge  grievances  on  the  designated  web-based  portal  or  mobile-based application  of  Central  Grievance  Redressal  Management  System  (CGRMS).  Alternatively, beneficiaries can reach out to NHA's National Call Centre through 24x7 helpline 14555 and register their grievances. Such grievances are resolved in an efficient and transparent manner through a publicly accessible IT platform.

Details of steps taken to improve implementation of AB-PMJAY are at Annexure.

## Details of steps taken to improve implementation of AB-PMJAY:

## Demand Side Interventions

- i. NHA  signed  Memorandums  of  Understanding  (MoUs)  with  leading  solutions providers  such  as  CSC  E-Governance  Services  India  Limited  (CSC)  and  UTI Infrastructure Technology and Services Limited (UTIITSL) to issue Ayushman cards free  of  cost  to  SECC  2011  beneficiary  undergoing  verification  for  the  first  time. State/UTs were encouraged to adopt such MoUs for non-SECC beneficiaries in their States.
- ii. 'Aapke Dwar Ayushman' (ADA) is a key initiative of NHA that is implemented in mission mode across 10 State/UTs, including focus States such as Bihar, Chhattisgarh,  Madhya  Pradesh,  and  Uttar  Pradesh.  The  campaign  leveraged  a grassroots network of healthcare workers, frontline workers, Panchayati Raj institutions, village level agents from CSC and UTIITSL to mobilize and verify nearly 4.2 crore beneficiaries.
- iii. NHA  has  reached  out  to  Central  Government  ministries  implementing  welfare schemes (Ujjwala Yojana, Awas Yojana) using SECC 2011 database. This was done to use the updated databases of such welfare schemes for better targeting of potential AB-PMJAY beneficiaries.
- iv. NHA  has  taken  steps  to  increase  avenues  for  Ayushman  card  generation  by onboarding additional agencies for card generation and card approval.
- v. Integration of pan-India Information, Education and Communication (IEC) campaigns of AB-PMJAY with other national flagship schemes.
- vi. NHA  has  launched  the  concept  of  Ayushman  Mitra  -  a  rewards  and  recognition program  to  transform  PMJAY  into  a  Jan  Andolan  by  creating  avenues  for  societal stakeholders to come forward and assist the scheme beneficiaries.

## Supply Side Interventions

- i. NHA has developed the concept of a beneficiary facilitation agency to increase the participation  of  empanelled  public  hospitals  by  streamlining  the  implementation  of PMJAY  at such hospitals and ensuring adequate attention to  AB-PMJAY beneficiaries.
- ii. A  dedicated  'Hospital  Operations'  unit  has  been  formed  at  NHA  to  engage  with healthcare providers and increase their participation under the scheme.
- iii. A focused approach is followed for empanelling majority of 100-bedded hospitals and top corporate hospitals under AB-PMJAY.
- iv. Settlement  of  claims  is  one  of  the  key  drivers  to encourage  participation  of empanelled  hospitals  and  thereby  improve  service  delivery  to  beneficiaries.  In  this regard, NHA has taken several measures to expedite claims adjudication.

<!-- image -->