4.34 crore hospital admissions costing Rs 51,749 crore authorised under govt’s health insurance scheme: Mandaviya – ET HealthWorld

New Delhi: A total of 4.34 crore hospital admissions entailing an expenditure of Rs 51,749 crore have been authorised under the government’s Ayushman Bharat health insurance scheme till February 2 this year, Union Health Minister Mansukh Mandaviya informed Lok Sabha on Friday. The average per capita expenditure under the scheme is Rs 11,924, Mandaviya said in a written response to a question.

The Ayushman Bharat Pradhan Mantri Jan Arogya Yojna (AB-PMJAY), launched in September 2018, provides a cover of up to Rs 5 lakh per family per year for secondary and tertiary care hospitalisation.

According to Mandaviya, a total of 23.07 crore beneficiaries have been verified under the scheme for issuance of Ayushman cards as of February 2, 2023. The minister further informed that a budget of Rs 6,412 crore has been allocated to be utilised under PMJAY for 2022-23 and Rs 4,580.10 crore has been utilised till February 2.

A total of 4.34 crore hospital admissions worth Rs 51,749.40 crore have been authorised under the scheme till February 2, he said. Empanelment of hospitals is voluntary on the part of intending private hospitals. Intending private hospitals apply for empanelment and get empanelled under the scheme subject to fulfilment of laid down criteria, he stated.

In a written response to another question, Minister of State for Health Bharati Pravin Pawar said that till February 2, the overall percentage of the total claims paid against total claims submitted under the scheme is approximately 77 per cent, while the percentage of claims paid to private hospitals is 86 per cent.

PMJAY is implemented in states and in partnership with respective state governments. The National Health Authority (NHA) has defined parameters for settlement of claims and the same is closely monitored at all levels.

States and Union territories are instructed to settle pending claims as per the claims adjudication guidelines. Further, in order to ensure timely release of state share for scheme implementation, the central share of funds is released only after upfront release of proportionate state share.

Listing the initiatives taken to streamline the payment mechanism under the scheme, Pawar said various monitoring dashboards are developed to trace claims pendency, claim payment, turn-around time of claim payment, etc.

The NHA has launched Green Channel Payment (GCP) wherein the provision of partial payment of 50 per cent of the claim amount automatically at the time of claim submission has been integrated into the NHA’s IT system.

The government said e-RUPI vouchers are issued to the beneficiaries for upfront payment for drugs and diagnostics services under the scheme.

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