Lok Sabha Question No. 644 (UNSTARRED), answered on 2022-02-04
Subject: Depriving of benefits under Ayushman Bharat Yojana
Ministry: HEALTH AND FAMILY WELFARE
Asked by: Sunil Kumar Pintu

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

## LOK SABHA UNSTARRED QUESTION NO. 644 TO BE ANSWERED ON 04 TH  FEBRUARY, 2022

## DEPRIVING OF BENEFITS UNDER AYUSHMAN BHARAT YOJANA

## 644. SHRI SUNIL KUMAR PINTU:

Will the Minister of Health and Family Welfare be pleased to state:

- (a)  the  whether it  is  a  fact  that  Ayushman  Card  holders  are  not  getting  required  and  adequate treatment in Government hospitals and are deprived of treatment/access to healthcare facilities in empanelled private hospitals under the scheme;
- (b) if so, the reasons therefor and whether such a situation has not defeated the very purpose of this scheme; and
- (c) if so, the immediate steps proposed to be taken to address these issues and make this scheme a success?

## ANSWER THE MINISTER OF STATE IN THE MINISTRY OF HEALTH AND FAMILY WELFARE (DR. BHARATI PRAVIN PAWAR)

(a) to (c): As of 28 th January 2022, approximately 2.75 crore hospital admissions worth over Rs. 30,750 crore are authorized under Ayushman Bharat - Pradhan Mantri Jan ArogyaYojana (ABPMJAY) through a network of more than 25,000 empanelled healthcare providers (public and private).

In case of denial of treatment by the empanelled hospital, beneficiaries can lodge grievance 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  grievance.In  case  of  denial  of treatment, stringent action is taken against the erring hospital.

Details of steps taken in this regard 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. Timely  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.

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