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NDTV
3 days ago
- Health
- NDTV
Medical Body IMA Flags Over Rs 1.21 Lakh Crore Unpaid Bills Under Ayushman Bharat
Over 9.84 crore hospital admissions have been approved under the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB PM-JAY), with payments exceeding Rs 1.40 lakh crore, the government informed parliament on Friday. The scheme, focused on universal health coverage, offers up to Rs 5 lakh annually in cashless hospitalisation to nearly Rs 55 crore economically weaker individuals, covering the bottom 40% of India's population. More than 41 crore Ayushman Cards have been issued, with Uttar Pradesh leading at 5.33 crore, followed by Madhya Pradesh, Bihar, and Odisha. Lakshadweep issued the fewest at 36,000. The scheme works through 31,466 hospitals, including over 14,000 private facilities, under Trust, Insurance, or Hybrid models, allowing state-specific flexibility. However, the Indian Medical Association (IMA) has raised serious concerns in a white paper to the National Health Authority (NHA). They highlighted problems such as delayed payments, low reimbursement rates, and complicated claim processes that threaten hospital finances. In Gujarat, Rs 300 crore in claims from 2021 to 2023 remain unpaid. Only 5% of these claims have been settled within the required 15 days. In Kerala, there are Rs 400 crore in pending dues, and nationwide over Rs 1.21 lakh crore in claims (64 lakh cases) are still outstanding, according to an RTI. The IMA also pointed out that package rates are too low and do not cover treatment costs, especially for complex procedures in private tertiary hospitals. "IMA should be invited while deciding rates, packages and we should ensure timely payments, ease of claims and simplfied procedures," IMA national president Dr Dilip Bhanushali told NDTV. Uniform pricing discourages high-quality hospitals, resulting in only 67 of Delhi's 1,000+ private hospitals participating due to operational and financial challenges. Claim rejections caused by technical errors further increase revenue losses. IMA Recommendations: - Automate payments and create real-time tracking for transparency. - Revise reimbursement rates to reflect actual costs, updating them regularly. - Simplify claim documentation and provide 24/7 digital support (e.g., WhatsApp, SMS). - Set up grievance redressal at district, state, and national levels. - Incentivise accredited and rural hospitals with higher payments and faster approvals. - Move to direct benefit transfers using fintech, avoiding third-party intermediaries, to improve efficiency and sustainability. - Encourage competition and address market failures, reducing payor biases and oligopsony effects that threaten small and mid-size providers. Minister Prataprao Jadhav acknowledged implementation challenges in the Rajya Sabha, urging states to adjust models for better efficiency. The IMA's white paper, submitted to the Rajya Sabha Standing Committee on Health, is awaiting a response from the NHA. Doctors warn that without reforms, the scheme's aim of providing free, quality healthcare for India's poorest is at risk.
Mint
20-06-2025
- Health
- Mint
Health ministry report bats for liver and heart transplants under PMJAY
New Delhi: The union health ministry has called for including liver and heart transplants under the government's flagship health insurance scheme, the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB PM-JAY). This assumes importance given that health insurance schemes in the country cover life and disability, but not organ donation. Also Read | Why are men ignoring their hormonal health? The recommendation comes in a report, titled the National Review Meeting on Organ Transplantation Activities in Government Hospitals, prepared by the National Organ Tissue Transplant Organization (NOTTO), a top body which manages organ transplantation, under the health ministry. The call for expanding insurance coverage comes in the backdrop of the low number of organ transplants performed in India. Mint has seen a copy of the report, which has been submitted to health ministry. Also Read | Want glowing skin? Take care of your mental health AB PM-JAY is the world's largest health insurance scheme, providing health cover of ₹5 lakh per family per year. Notably, the scheme's ambit has been expanded to include free treatment benefits of up to ₹5 lakh per year to senior citizens aged 70 years and above. Earlier this month, a nationwide review meeting was conducted on organ transplants in government hospitals by a group of top government experts to identify bottlenecks in the system and formulate a roadmap for improvement. The report underlined that government institutions have inadequate capacities and that new centres are required to be established and made functional. It emphasized the need for a multi-pronged strategy involving policy changes, financial investment, and capacity building to bridge the demand-supply gap in organ transplantation. Also Read | ₹1-crore health cover is fast becoming a necessity. But how to afford one? The report highlighted a huge gap between demand and supply: while India requires at least 100,000 kidney transplants per year, only 13,476 were performed in 2024 across both government and private centers. 'These recommendations aim to strengthen India's organ transplantation capabilities and make life-saving procedures more accessible to those in need. During the nationwide assessment of the government hospitals, we identified their challenges and suggested measures to improve their capabilities in terms of infrastructure, finance, manpower etc. We have submitted our report to the health ministry and now the ministry will take action on these recommendations," said Dr. Anil Kumar, director, NOTTO. One of the key recommendations is to include comprehensive inclusion of liver and heart transplantation in national health schemes like PMJAY, he added. 'Some states like Maharashtra and Delhi have expanded their coverage under the PM-JAY scheme. So, the recommendation of the report to include liver and heart transplantation under PM-JAY may be considered to accelerate organ transplantation in the government institutions," he said. Dr Anup Kumar, head of kidney transplant and urology department at Safdarjung Hospital, New Delhi, said, ' It is a welcome move. PMJAY offers coverage of up to ₹5 lakh, but these are very expensive procedures require ₹20-25 lakh in the private sector. However, in government institutions these transplants can be done in ₹10 lakh. So, to cover these two transplants, the government has to also consider increasing the coverage plan of PMJAY from ₹5 lakh to at least ₹10 lakh." Further, to bridge the critical demand-supply gap, the expert group has put forth several key recommendations, which include financial incentives for transplant teams, enhanced funding for infrastructure development, establishment of dedicated transplant centres and robust training programmes for medical personnel and transplant coordinators. 'We have tried to understand why government institutions are not able to do the maximum number of organ transplants and what are the solutions. Do we require to build new centres or strengthen the existing capacities. Some government centres like Institute of Kidney Diseases and Research Centre (IKDRC) Ahmedabad conducted a total of 508 organ transplants in the last year, including 195 cadaveric transplants, PGIMER Chandigarh performed 320 organ transplants including 55 cadaveric transplants," Dr. Kumar said. However, the report revealed that government institutions like GB Pant Hospital, New Delhi, despite having the physical infrastructure and licence, did not perform any organ transplants.
The Hindu
18-06-2025
- Health
- The Hindu
Free treatment under Vay Vandana scheme for senior citizens aged 70 and above still elusive in Karnataka
Free treatment for senior citizens aged 70 and above, under the Ayushman Bharat Vay Vandana (ABVV) scheme, is still elusive in Karnataka. This is because the State's Finance Department has not agreed to the Centre's assurance that the modalities for release of grants for the scheme will be finalised soon. Responding to the State's letter seeking adequate support to implement the Vay Vandana scheme, which is an extended part of the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB PM-JAY), the Centre has requested Karnataka to start providing the services and that the payment modalities for additional cost will be worked out soon. Sharing ratio Expressing the State's inability to start the Vay Vandana scheme without any clarity on the fund release, Karnataka's Principal Secretary (Health) Harsh Gupta had written to the Union Health Secretary pointing out that the State is entitled to get ₹36.58 crore from the Centre for the scheme as per the 60:40 sharing ratio of Ayushman Bharat Arogya Karnataka (AB-ArK) scheme. 'Although the sharing ratio for the health scheme between the Centre and State should be 60:40, it is actually 25:75 as the State bears expenditure for around 1.12 crore families while the Centre is only funding the expenses of 69 lakh families as listed under the Socio Economic and Caste Census (SECC) 2011 data,' he said in the letter. Of the total AB-ArK beneficiaries, the State has around 15.12 lakh families with senior citizens as members. Of these, 9.22 lakh are SECC-identified families (tagged families), and the remaining are over and above the SECC-identified families (untagged families). 'The Centre will provide the State with additional support at the rate of a mere ₹75.7 per family per annum for tagged families and ₹1,052 per family per annum for the untagged families. However, additional support to the untagged families will be provided only after the 69 lakh families out of 1.12 crore total families are tagged,' the letter stated. NHA's letter In response to this, L.S. Changsan, Chief Executive Officer of the National Health Authority (NHA) that is the implementing agency for AB PM-JAY, said the additional premium for existing beneficiary families determined at ₹75.7 per family per annum covers the additional top-up wallet of ₹5 lakh, which is utilised only after the primary wallet of the family is exhausted. For new beneficiary families, the annual premium of ₹1,052 per family aligns with the existing premium structure under AB PM-JAY, the NHA CEO's letter stated. 'Based on the consultations with States in July 2024 and the inputs received subsequently, the principles for tagging are being finalised. The identification of existing families and new families will be done based on these principles. However, the State may start providing the services to the Ayushman Vay Vandana card holders and tagging activity will be completed before fund release proposals for the ABVV are due,' the letter said. No definitive mechanism However, Karnataka's Finance Department has not agreed to this. 'In the absence of any definite mechanism to link the AB-ArK beneficiaries with the actual SECC data, as per the next best approximation worked out by the State Health Department, Karnataka will require a total of ₹68.98 crore per annum for the senior citizens scheme. As the Centre has to provide 60% of this amount to the State, Karnataka is entitled to get ₹36.58 crore from the Centre. We are now planning to place this issue before the State Cabinet for further discussion,' Mr. Harsh Gupta told The Hindu.
Indian Express
16-06-2025
- Health
- Indian Express
How to download Ayushman Card online in 2025?
Ayushman Bharat Card Online Download 2025: The Government of India introduced the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB PM-JAY) to reduce the cost of healthcare services for low-income families in 2018. It serves as a lifeline for low-income families, offering cashless hospitalisation coverage of up to ₹5 lakh annually per family. Early this year (2025), Delhi CM Rekha Gupta declared that the Delhi state government will provide an extra 5 lakh on top of the 5 lakh coverage offered by the federal government. Notably, the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB PM-JAY) introduced health cards last year to offer health care to everyone 70 years of age or beyond, irrespective of their financial situation. However, you need to hold the Ayushman Bharat Card to receive benefits under this system. While there are two convenient methods for downloading the Ayushman Card – online and offline – the following is a step-by-step guide to get access and download the Ayushman Bharat Card for any state online. Individuals can download an Ayushman card online from the official Ayushman Bharat website. Step 1: Start by visiting the official website of PMJAY at Step 2: From the top menu, select the 'Am I Eligible' item. Step 3: Once your phone number, OTP, and captcha code have been entered for verification, click 'Login'. Step 4: Click 'Search' after entering the necessary data and selecting 'State', 'Sub-scheme' (such as 'PMJAY'), 'District', and 'Search By'. Step 5: The 'Do e-KYC' button should be clicked next. Step 6: Choose the 'Aadhaar OTP' option. Your Aadhaar number is visible to you. Press 'Verify'. Step 7: Tick the consent and click 'Allow'. Enter the Aadhaar OTP and mobile OTP. You will get the completion of the e-KYC message. Step 8: Log in to the PMJAY website after 15-20 minutes of e-KYC and click the 'Download Card' button. Step 9: Next, select the 'Aadhaar OTP' option, view your Aadhaar number and click 'Verify'. Step 10: Click 'Allow' after checking the consent box. Enter the cellphone and Aadhaar OTPs. You will receive the e-KYC message in its entirety.
Hans India
09-06-2025
- Health
- Hans India
Katihar ranks third in Bihar in generating Ayushman Cards, 80,000 issued so far
In a significant achievement under the Central government's flagship healthcare initiative, the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB PM-JAY), Katihar district has secured the third position in Bihar for generating Ayushman cards. With over 80,000 cards issued so far, the district has earned a spot among the top ten in the state, reflecting growing public engagement with the scheme. District Magistrate Manish Kumar Meena called on residents to take full advantage of the Ayushman Bharat scheme, describing it as one of the most ambitious and impactful initiatives of the Central government. "Under this scheme, individuals can avail free health treatment worth up to Rs 5 lakhs per family per year. I urge all ration card holders to visit their designated Kendras and get their Ayushman cards made without delay," he said. Speaking to IANS, Deputy Development Commissioner of Katihar, Amit Kumar, shared further insights. "We launched the card generation campaign across Bihar on May 26, rolling it out at the ward level. Despite facing challenges like heavy rains, Katihar managed to perform exceptionally well, securing the third spot in the state. So far, 80,000 Ayushman cards have been generated, and we aim to further increase this number in the coming days." The Ayushman Bharat PM-JAY is the largest health assurance scheme globally, targeting over 12 crore poor and vulnerable families - about 55 crore individuals - who make up the bottom 40 per cent of India's population. The scheme offers annual health cover of Rs 5 lakhs per family for secondary and tertiary hospitalisation. Beneficiaries are identified based on the Socio-Economic Caste Census (SECC) 2011 data for both rural and urban areas. Launched in 2018, the AB PM-JAY merged with the previous Rashtriya Swasthya Bima Yojana (RSBY) introduced in 2008. It ensures cashless treatment for beneficiaries at the point of service, i.e., at empanelled hospitals. The program is fully government-funded, with implementation costs shared between the Centre and states. The initiative is part of the broader Ayushman Bharat Mission, which aims to reduce out-of-pocket health expenses, improve access to quality care, and push India closer to Universal Health Coverage. It includes the Ayushman Bharat Digital Mission, which has enabled the creation of over 77 crore digital health IDs, connecting citizens to seamless healthcare services. In addition, the government has also launched the Ayushman Vay Vandana Yojana, extending benefits to all citizens aged 70 and above, regardless of income. On Monday, marking the completion of 11 years of the Modi-led government, Union Health Minister J.P. Nadda highlighted the impact of the Ayushman Bharat initiative. "In the last 11 years, there has been historic development across sectors—education, health, transport, infrastructure, and defence. The Ayushman Bharat-Jan Arogya Yojana has revolutionised healthcare access for millions," Nadda stated in a post on social media platform X. As of May 30, over 41.02 crore Ayushman cards have been issued across 33 states and Union Territories. The scheme has facilitated 8.59 crore hospital admissions amounting to Rs 1,19,858 crore, offering a critical lifeline for millions and preventing families from falling into debt due to medical costs. Furthermore, the number of Jan Aushadhi Kendras providing affordable generic medicines has surged from just 80 in 2014 to 16,469 as of May 30, significantly improving access to essential drugs for the common citizen.
