Chhattisgarh congressional government to replace Modi-backed health insurance scheme with new plans
Less than a month after a large electoral victory in Chhattisgarh, the state congressional government announced its intention to replace the Modi government’s national health care system, the Pradhan Mantri Jan Aarogya Yojana or PMJAY, with a new universal health care.
Instead of using insurance to cover the hospital costs of poor patients, the state government says it will strengthen primary and preventive health care by strengthening public health facilities, as promised in its manifesto. electoral.
“We are looking at universal health coverage and PMJAY only offers uneven coverage,” Chhattisgarh Health Minister TS Singh Deo said. The central plan will be phased out over two years while the state develops its own universal health plans.
PMJAY covers hospital costs of Rs 5 lakh per family for the poorest 40% of the Indian population, or about 10 crore of beneficiaries. It is based on an insurance model, but each state can choose to partner with an insurance company or create a trust to manage the scheme.
The Center contributes 60% of the costs of the program while the rest of the funds come from the States. Delhi, Odisha and Telangana have not yet chosen to implement PMJAY, which means these states will not receive funding from the center to provide health coverage.
In Chhattisgarh, Singh Deo said the electoral mandate showed support for a withdrawal from the Modi government’s insurance scheme. “We fought this election knowing that PMJAY was already implemented and we took a stand against the Rs 5 lakh program,” he said. âPeople voted for us.
The congressional election manifesto promised to provide “free quality health care” by hiring highly qualified doctors for the treatment of serious illnesses and modernizing public hospitals with modern facilities.
The government of Chhattisgarh is now in the early stages of developing new health plans. It is setting up consultations with public health experts to discuss ways to give patients access to free medicines and diagnostics, to strengthen primary and community health centers and to ensure that all health facilities. public health have sufficient staff. A government adviser said that 86% of specialist medical positions in Chhattisgarh are currently vacant.
From now on, the state government intends to use the Centre’s funds available from both the PMJAY and the National Health Mission to start modernizing the primary health facilities in Chhattisgarh. . When the State launches its own program, it will not be able to benefit from PMJAY funds but will have to apply separately to the Center for assistance. However, the state government is hopeful that there will be a congressional-led government at the Center in a few months and the new government ditching PMJAY in favor of a similar approach to nationwide health care.
Reservations on PMJAY
So far, Chhattisgarh has implemented two health schemes: the Rashtriya Swasthya Bima Yojana or RSBY, which was the existing national health insurance scheme before PMJAY for families living below the poverty line, and the Mukhyamantri Swasthya Bima Yojana at the state level for families above the poverty line. Both regimes were to be included in the PMJAY.
Explaining why the Chhattisgarh government was going to move away from PMJAY, Singh Deo said doctors were not happy with the flat rates of the 500 new PMJAY plans and that they were unlikely to treat patients with these. conditions. PMJAY covers approximately 1,300 medical and surgical procedures of which approximately 800 had already been covered by RSBY.
He said that RSBY’s experience has shown that many hospitals refuse to treat patients eligible for the program and that patient reimbursements are denied.
He also expressed reservations so that patients only become eligible for PMJAY if they are hospitalized, leaving them to bear the burden of diagnostic and drug costs before hospitalization.
The state government plans to launch a program to provide free diagnostics and medicine to poor families before it even rolls out its new health program and while PMJAY is still operating in the state.
âProviding 100% free diagnostics and medicine is easily achievable,â Singh Deo said. The budget for this is not large and will be around Rs 300 crore.
Support from public health activists
Since PMJAY was announced in the 2018 budget, public health activists have lambasted the idea on the grounds that it would divert taxpayer money from the public health system to the private sector.
They say it will lead to over-medicalization of health care without solving the problems of fraudulent claims and unnecessary procedures performed to access insurance money, as existing plans show.
Jan Swasthya Abhiyan issued a People’s Health manifesto in December in which he called for the abandonment of the PMJAY nationwide and the integration of existing state-funded health insurance schemes into a expanded and strengthened public health system.
âWe have found that much of the research on the experience of these programs shows that the government is investing more and more money in the private sector while the people who need it do not get services or continue. to have high levels of direct spending. “, said Sulakshana Nandi, co-national manager of Jan Swasthya Abhiyan.
Nandi said insurance plans have also prompted government doctors to practice their private practices and unethically refer beneficiaries of the insurance plan to their private clinics for payments instead of them. deal in the public sector. She said it was important for the state and the national government to ban the private practice of government doctors, but also to ensure that they are paid better.
âWe are happy that the government of Chhattisgarh is reconsidering the PMJAY,â she said, noting that models of providing free diagnostics and medicines already exist, with similar programs being implemented in Tamil Nadu, Delhi and in Rajasthan.