Tamil Nadu ranks second in the country in the amount claimed under the Centre’s flagship health insurance scheme, Ayushman Bharat –Pradhan Mantri Jan Arogya Yojana (AB-PMJAY). Though the total number of claims is relatively less — T.N. being ranked fourth in this category — the claim amount is high as the State performs high-end procedures including eight procedures that no other State performs under the scheme, officials said.
The Union Ministry of Health and Family Welfare, in response to a question raised in Parliament on the implementation of AB-PMJAY, said the total claim amount submitted by States and Union Territories was nearly ₹3,077 crore.
Gujarat topped the list with a claim amount of nearly ₹641 crore followed by Tamil Nadu with a claim amount of ₹399 crore as on June 18, 2019; the Centre had rolled out the scheme in September 2018. Tamil Nadu, which already had its own Chief Minister’s Comprehensive Health Insurance Scheme (CMCHIS) , chose to coalesce its programme into the Ayushman Bharat Scheme.
Tamil Nadu’s number of claims — not necessarily equivalent to the number of patients utilising the scheme as some patients may undergo more than one treatment – was less when compared to Chhattisgarh (5,07,707), Gujarat (3,94,995) and Kerala (2,74,298). The State had 2,11,075 claims in its fold.
“The State stands second in the claim amount. When it comes to the claim size, we do more number of high-end procedures. For instance, we do more number of cardiac surgeries and so, the average package size is more. In case of a small intervention such as root canal, the package size is less,” said T.S. Selvavinayagam, additional director of Public Health and Preventive Medicine.
All cardiac surgeries such as Percutaneous Transluminal Coronary Angioplasty and Coronary Artery Bypass Grafting are covered under the health insurance scheme. In addition to this, all oncological procedures including chemotherapy and radiation are done here, he said. “We do eight high-end procedures that no other State does under the scheme. This includes renal and liver transplants. We have more number of tertiary care procedures covered,” he explained. When the State integrated its CMCHIS with AB-PMJAY last year, the coverage was raised to ₹5 lakh per family.
Since the inception of CMCHIS in 2012 followed by the integration, 35,22,707 clients were approved for coverage, while the approved amount was nearly ₹6,023 crore. Government hospitals alone accounted for 13,12,682 approved clients and approved amount of nearly ₹2,162 crore, as per official data.
