The All India Institute of Medical Sciences (AIIMS) has written to the National Health Authority (NHA) and the Union Ministry of Health and Family Welfare, pointing to how several of its patients with life-threatening illnesses are slipping through the cracks between two key Central health schemes — the flagship Ayushman Bharat-Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) and the umbrella scheme of the Rashtriya Arogya Nidhi (RAN).
These patients, suffering from illnesses such as end-stage renal disease, chronic kidney disease, chronic liver disease and blood cancer, are denied treatment under AB-PMJAY since these illnesses are not among the 1,350 medical packages defined under the scheme and hence not covered. But they are also often deprived of benefits under the earlier RAN scheme since they are AB-PMJAY card holders.
In several cases, applications sent by the medical institute were rejected by the ministry, despite being approved by the AIIMS technical committee. In its letter, the AIIMS administration requested that a possibility be explored to accommodate patients deprived under AB-PMJAY in the RAN umbrella scheme.
Though the letter was sent by AIIMS Medical Superintendent Dr D K Sharma on August 10, Union Health Secretary Preeti Sudan said she hadn’t received the letter yet. “I will take action after looking at it,” she told The Sunday Express.
“Patients unable to avail financial assistance due to the lacunae between RAN umbrella scheme and AB-PMJAY schemes are coming to us in severe distress after their RAN application is rejected, as they have no option left for financial assistance. Both schemes must complement each other to help patients suffering from life-threatening diseases. On the contrary, certain poor patients are deprived of healthcare benefits, against the situation before 2019, when all BPL patients suffering from life-threatening diseases were able to avail financial assistance from RAN,” stated the letter.
Among those whose applications were rejected are the family members of 12-year-old Nandani Kumari. The girl, suffering from aplastic anaemia, required a bone marrow transplant. Hailing from Bihar, she was brought to the medical institute in December 2018. She died on August 12.
“There is nothing more to say, we have lost our child. We came with all necessary documents like BPL card and Ayushman Bharat card. When we approached authorities, we were told this disease is not covered under AB-PMJAY. The RAN department said that since we are Ayushman Bharat card holders, we cannot be provided financial assistance. I could not afford Rs 12-15 lakh (needed for the transplant),” said Vibhanshu Prasad, her father, who works as a security guard.
Harminder Singh, 54, from Bareily says that in May 2018, he visited AIIMS, where doctors suggested a kidney transplant. “I submitted all documents, but my file recently came back from the ministry. I have once again given my documents.”
In September 2018, AIIMS became the first hospital in Delhi to become a part Ayushman Bharat, the government’s ambitious scheme which completes a year on September 23.
On June 7 this year, the Ministry of Health and Family Welfare wrote to government institutes, health secretaries, regional and state cancer centres and tertiary care centres, clarifying the process of implementation of the Umbrella RAN scheme. The guidelines explained how families covered under AB-PMJAY will not be eligible for RAN and the Health Minister’s Cancer Patient Fund (HMCPF), a smaller scheme that’s part of hthe larger RAN umbrella.
However, it said patients suffering from rare diseases specified in the RAN scheme and belonging to socio-economic categories eligible to be AB-PMJAY beneficiaries would also be considered for packages not covered under Ayushman Bharat.
The AIIMS letter, however, states, “The rare disease list mentioned in the RAN umbrella scheme is obviously very limited, so AB-PMJAY beneficiaries suffering from chronic kidney and liver disease, ESRD, aplastic anaemia and those in need of cancer transplants have no option to avail life-saving financial assistance from either of the schemes. This goes against the spirit of RAN and there seems to be a gap left between the two schemes.”
Significant life-saving packages for bone marrow, kidney, liver, heart and lung transplants are not covered under AB-PMJAY. Doctors say RAN has been a lifeline for poor patients suffering from these life-threatening illnesses.
Indu Bhushan, CEO of NHA, told The Sunday Express, “We support the letter and recommend to the Ministry that even patients covered under AB-PMJAY should have access to RAN scheme, especially after they have exhausted the limit. We have also requested the Health Minister to provide the facility to the patients.”
Other issues AIIMS flagged
* AB-PMJAY packages rates are not commensurate with actual costs incurred/estimates provided by the doctor
* AB-PMJAY scheme provides coverage of medicines post discharge up to 15 days only, whereas certain cancer patients require long-term medications on outpatient basis and hence cannot be extended benefits under AB-PMJAY scheme, which requires in-patient admissions as per rules. These patients, AIIMS said, may be extended benefits under the RAN scheme
* Some states have portability restrictions due to which the AB-PMJAY beneficiaries being treated at AIIMS cannot avail benefits of the scheme outside their state