Around 1.25 lakh patients sought complex tertiary care procedures including surgical oncology, radiation oncology, cardiac bypass and total knee replacements in the last two months under the government’s flagship Ayushman Bharat health insurance scheme. Constituting over 33 percent of the total 3.75 lakh hospitalizations, the tertiary care procedures assume significance since these treatments are exorbitantly priced in private hospitals and therefore been mostly out of the reach of poor so far. While secondary care procedures like dental surgeries, general medicines constitute a larger share with over 66 percent of the cases, the claims are higher for tertiary care cases. Data compiled by the National Health Agency shows tertiary care accounts for Rs 150 crore or 37.8 percent of the total Rs 396 crore of claims approved so far.
Moreover, the government is also expecting a gradual increase in number of tertiary care cases with expansion of its hospital network and with specialty hospitals coming on board. Currently, there are around 13,000 multispecialty and 10,000 specialty hospitals empaneled under the scheme. Through PMJAY the government is targeting to increase healthcare accessibility of tertiary care by 6000 to 7000 patients per day. Pradhan Mantri Jan Aarogya Yojana (PMJAY) — the secondary and tertiary care arm of Ayushman Bharat — aims to cover nearly 50 crore beneficiaries from 10.74 crore deprived families. “We are hoping that increase in tertiary care accessibility will result in fewer number of deaths from diseases like cancer and cardiac conditions. Besides, it will lower out-of-pocket medical costs and reduce the chances of having catastrophic expenditures that are likely to push people into poverty,” says Dinesh Arora, deputy chief executive of Ayushman Bharat.
However, to achieve the set target, the government will have to aggressively expand its hospital network, mainly focusing on bigger chains providing multispecialty care. Currently, the network of hospitals empaneled under Ayushman Bharat includes mostly smaller nursing homes and facilities which are less than 30 bedded. The number of bigger hospital facilities across the country remain low. Despite the low number of bigger and branded facilities under the scheme, data shows around 68 percent of the total beneficiaries admitted to hospitals received treatment in private hospitals. – TOI