Patients were caught in the ambit of loopholes and were slipping through the crack between the AB-PMJAY and RAN schemes.
The two benchmark health schemes of the government have left the patients with life-threatening illnesses confused. The flagship scheme of Modi government, the ‘Ayushman Bharat-Pradhan Mantri Jan Arogya Yojana’ (AB-PMJAY) and the umbrella scheme called the ‘Rashtriya Arogya Nidhi’ (RAN) has certain provisions which are causing the patients to avail benefits in the cases of some life-threatening illnesses. The All India Institute of Medical Sciences or AIIMS has written to the Union Ministry of Health and Family Welfare (MoHFW) and the National Health Authority (NHA) in this regard. The premier medical institute of the country in the aforementioned letter has pointed out how several of its patients with life-threatening illnesses were unable to avail the facilities from either of the schemes. These patients were caught in the ambit of loopholes and were slipping through the crack between the AB-PMJAY and RAN.
Under the AB-PMJAY, patients suffering from illnesses like end-stage renal disease, chronic kidney disease, chronic liver disease and blood cancer were denied treatment. These illnesses did not fall under the ambit of the 1,350 medical packages defined under the AB-PMJAY scheme and hence were not covered. On the other hand, these patients were often also deprived benefits under the earlier RAN scheme as they are AB-PMJAY cardholders.
In several cases, despite the application being approved by the AIIMS technical committee, the ministry rejected them. AIIMS administration in its letter has requested the government bodies to explore possibilities for the accommodation of patients deprived under AB-PMJAY in the RAN umbrella scheme.
According to a report Published in the IE, Union Health Secretary, Preeti Sudan, reportedly told The Sunday Express that she hadn’t received the letter yet. Actions will be taken once the letter is received. She stated, “I will take action after looking at it.” The letter was sent by Dr D K Sharma, AIIMS Medical Superintendent on August 10.
AIIMS became the first hospital in Delhi to become a part of Ayushman Bharat, the government’s health scheme which will complete a year on September 23. Earlier on June 7 this year, the Ministry of Health and Family Welfare wrote to different bodies including the government institutes, health secretaries, regional and state cancer centres and tertiary care centres, clarifying about the process of implementation of the government’s Umbrella RAN scheme.
The guidelines from the ministry explained ‘how families covered under Ayushman Bharat scheme (AB-PMJAY) will not be eligible for RAN scheme and the Health Minister’s Cancer Patient Fund (HMCPF). HMCPF is a smaller scheme and is part of the larger RAN umbrella.
However, the ministry said that patients who are suffering from rare diseases and are specified in the RAN scheme and belonging to socio-economic categories are eligible to avail the AB-PMJAY benefits too and would also be considered for packages not covered under the Ayushman Bharat scheme.
Whereas, the letter by AIIMS stated, “The rare diseases mentioned in the list of RAN umbrella scheme are obviously very limited. But the AB-PMJAY beneficiaries who are suffering from serious illnesses like chronic kidney and liver disease, ESRD, aplastic anaemia and those in need of cancer transplants, cannot avail life-saving financial assistance from either of the schemes. This seems to be a big loophole between these two schemes and is against the spirit of RAN.”
Doctors state that RAN scheme has been a lifeline for poor and financially weak patients suffering from life-threatening illnesses. Whereas, significant life-saving packages for bone marrow, kidney, liver, heart and lung transplants do not fall under the ambit of AB-PMJAY.
The CEO of NHA, Indu Bhushan told The Sunday Express that we support the letter and recommend to the Ministry that the patients who avail benefits of the AB-PMJAY scheme and are suffering a serious illness, should have access to RAN scheme as well, especially after they have exhausted the financial limit of the scheme.”
AIIMS also highlights certain other severe issues. The medical institutions stated that the AB-PMJAY packages rates do not sync up aptly with the actual costs incurred/estimates provided by the doctor, which is an issue for financial weak patients.
AIIMS also pointed out that the AB-PMJAY scheme provides coverage of medicines post-discharge only up to 15 days. But in certain cases, like cancer patients, a long-term medication on an outpatient basis is required and hence are unable to avail benefits under AB-PMJAY scheme as the rules of the scheme require in-patient admissions. Such patients may be extended benefits under the RAN scheme, AIIMS said.
It is to be noted that amidst all the loopholes and paperwork the trouble is actually being faced by the poorer section of the society, which has high hopes of availing better healthcare facilities.