Lok Sabha Question No. 1046 (UNSTARRED), answered on 2023-12-08
Subject: Treatment of Orthopaedic Diseases under Ayushman Bharat Yojana
Ministry: HEALTH AND FAMILY WELFARE
Asked by: Rajiv Ranjan (Lalan) Singh, Santosh Kumar

## GOVERNMENT OFINDIA MINISTRY OF HEALTH AND FAMILY WELFARE DEPARTMENTOFHEALTHAND FAMILYWELFARE

## LOK SABHA UNSTARRED QUESTION NO. 1046 TO BE ANSWERED ON 08 TH DECEMBER, 2023

## TREATMENT OF ORTHOPAEDIC DISEASES UNDER AYUSHMAN BHARAT YOJANA

## 1046. SHRI RAJIV RANJAN SINGH ALIAS LALAN SINGH: SHRI SANTOSH KUMAR:

Will the Minister of HEALTHAND FAMILYWELFARE be pleased to state:

- (a) whether the Ayushman Card beneficiaries do not get any benefit for the treatment of orthopaedic diseases;
- (b) if so, the details thereof along with the reasons therefor;
- (c) whether there has been instances where Ayushman Card holder patients have been denied treatment/financial benefits;
- (d) if so, the details thereof along with the number of such complaints received against AIIMS, New Delhi; and
- (e) the necessary steps taken/proposed to be taken in this regard?

## ANSWER THE MINISTER OFSTATE IN THE MINISTRY OF HEALTH AND FAMILY WELFARE (PROF. S. P. SINGH BAGHEL)

(a) to (e): Ayushman Bharat Pradhan Mantri -Jan Arogya Yojana(AB PM-JAY) provides treatment corresponding to a total of 1949 procedures under 27 different specialties including orthopaedics, oncology, cardiology and general medicine, etc. Of these, a total of 141 procedures are related to orthopaedic diseases. Further, as on 4 th of December 2023, 20.25 lakh hospital admissions worth approximately Rs. 5,289.4 Crores have been authorized under the scheme for orthopaedic-related treatment.

A Central Grievance Redressal Management System (CGRMS) has been established for any complaint received either through the national call centre or on grievance redressal portal (https://cgrms.PM-JAY.gov.in/) or through any other medium. The same is immediately assigned to respective State Grievance Nodal Officer designated at each SHA for necessary action. Many times, grievances are raised by the beneficiaries due to lack of awareness e.g. grievance registered against a hospital for not providing treatment under speciality for which it has not been empanelled.

AIIMS is the apex tertiary care hospital in the country and therefore it attracts patients from across the country. AIIMS while admits the emergency cases immediately, it sometimes provides a subsequent date in case of elective surgery based on the bed availability. Patients seek support from implementing authority under AB PM-JAY for early date of surgery/ admission. Wherever possible, support is provided to the beneficiaries. Out of 4,198 such grievances received from across the country against different empanelled hospitals, 4,117 have been resolved. Further, 16 such grievances have been received with regards to AIIMS, Delhi, all of which have been resolved successfully.

The hospitals empanelled under AB PM-JAY are bound to offer cashless treatment to eligible beneficiaries for the specialties it has been empanelled. Failure to do so may result in penal action which may include, de-empanelment. In case beneficiaries are denied treatment, one can lodge grievance on the portal, through national call centre 14555 or through mail, letter, fax etc. which will be acknowledged, recorded, escalated and resolved as per well-defined process. All grievances of AB PM-JAY beneficiaries are resolved in an efficient, transparent and time bound manner through a three-tier grievance redressal structure.

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