Delhi’s new Cabinet sets 30-day target: 1 lakh Ayushman sign-ups, 553 Mohalla clinics to transform

Beneficiaries of the insurance scheme, under which eligible families get a health insurance cover of Rs 5 lakh, will be selected on the basis of National Food Security Act data, and Socio Economic and Caste Census 2011. Senior citizens aged above 70 will also be included.

According to the minutes of the meeting called by Special Secretary (Health and Family Welfare) Danish Ashraf on Tuesday, an overhaul of Delhi government and municipal dispensaries as Ayushman Arogya Mandirs-Primary Health Clinics (AAM-PHCs) is also on the cards. For this, a target has been set to upgrade 11 primary health clinics within 30 days.

The instructions were given to officers in the Delhi Health Department, state Health Mission as well as District Magistrates at the meeting.

The officials are also planning to upgrade 553 existing Mohalla Clinics to Urban Ayushman Arogya Mandirs (U-AAMs). They also discussed the need to operationalise an additional 413 new U-AAMS under PM-Ayushman Bharat Health Infrastructure Mission (PM-ABHIM).

The PM-ABHIM is a central government scheme that aims to strengthen public health infrastructure to respond to future pandemics and outbreaks.

“A requirement for a new U- AAM as per population of the district may be submitted. It was emphasised that the new facilities should be to the extent possible be in any Government lands/buildings. Also 11 new Model U-AAMs to be established (one each in every District of GNCTD) within 30 days of approval of scheme and DMs need to submit the details of such facilities for upgradation,” said the minutes of the meeting.

Training for staff who will generate golden cards under the insurance scheme and those who will work to pre-authorise medical procedures, meanwhile, has already started. The National Health Authority, along with Delhi’s new BJP government, is also working to create the beneficiary database.

According to the Ayushman Bharat scheme, an estimated 6.54 lakh of the poorest families in Delhi will receive health coverage up to Rs 5 lakh. Importantly, 4.5 lakh families with people over the age of 70 — some of whom may already be eligible for cover as per their economic status — will also benefit.

The Delhi government will provide an additional cover of Rs 5 lakh to those eligible, Chief Minister Rekha Gupta said after Thursday’s Cabinet meeting.

The previous AAP government had refused to implement Ayushman Bharat in Delhi on the grounds that its own schemes were better. The AAP’s schemes included free treatment for all citizens in government hospitals and free surgeries in 81 private hospitals for those who had to wait a long time for diagnoses and treatment in government-run hospitals.

“The beneficiary database is being created right now. The poorest Delhi residents, those aged above 70 years, and ASHA and Anganwadi workers will be covered. In addition, the state may also provide cover for transgender individuals, construction workers, sanitation workers, and any other category of individuals,” said a Health Ministry official.

Under the scheme, every state has a quota of the number of beneficiaries for which the Centre provides a share of the premium — the state may choose to cover additional beneficiaries through the same system by paying the entire premium.

TRUST MODEL

The first step towards rolling out the Ayushman Bharat insurance scheme in Delhi will involve signing a Memorandum of Understanding (MoU) between the Centre and the state. This will happen after the back-end preparations are in place. With Delhi signing on to the scheme, after Odisha earlier this year, West Bengal is now the only state that is not covered under the scheme.

Ayushman Bharat is largely implemented in two ways. One, the trust model in which the state health authority is registered as a trust and is responsible for purchasing the services directly from empanelled hospitals. Two, the insurance model in which the state contracts an insurance company to cover the beneficiaries. In the second model, the insurance company is responsible for pre-authorising treatments, processing claims, and fraud detection.

Delhi will initially go in for a trust model, said officials. “The scheme will start off with a trust model. It takes longer to set up Ayushman Bharat through the insurance model because tenders have to be floated to secure a contract with an insurance provider,” said an official, adding that the state may later move to the insurance model.

A 2022 analysis of the implementation of the two models in six states — carried out by the National Health Authority in collaboration with the World Health Organization — found that the insurance model registered more beneficiaries, rejected fewer claims, had higher utilisation and hospitalisation rate, but fewer empanelled hospitals.

TRAINING PROCESS

Currently, master trainers are being trained to generate new Ayushman Bharat cards. They will go on to train others, totalling 6,000 people. At the same time, back-end staff are also being trained. “As soon as Ayushman Bharat cards are generated, people file for claims. This means we have to have the back-end in place before the scheme is rolled out. These back-end personnel will be responsible for taking care of the pre-authorisation process before the treatment begins,” an official said.

The Delhi government is also in the process of notifying members for various administrative structures such as the State Health Authority responsible for the functioning of the entire scheme, the empanelment committee responsible for enrolling hospitals under the scheme, the grievance redressal committee, fraud detection unit, and auditing teams.