A few days ago, Kargil resident Stanzin Garab travelled to Delhi with his Ayushman Bharat-Pradhan Mantri Jan Arogya Yojana (PMJAY) beneficiary card, with high hopes of returning home cured. However, after he reached AIIMS, Delhi, the bad news struck — the treatment of his severe aplastic anaemia, a disease of the bone marrow, would require Rs 10 lakh. That is double the annual family cap under PMJAY.
Several rounds of communication between AIIMS, the Health Ministry and the National Health Authority (NHA) — which administers PMJAY — have failed to find a permanent solution to the question of what happens to patients like Garab, who are eligible for PMJAY but whose treatment expenses are way too expensive for the flagship health programme to cover.
They are stuck between two schemes — PMJAY, which decides eligibility on the basis of the data of the socioeconomic caste survey (SECC) of 2011, where families are listed by “deprivations”, and the Rastriya Arogya Nidhi (RAN), which is an annual corpus allocated to the Health Ministry for treatment of below poverty line (BPL) patients.
Launched in September 2018, PMJAY is the tertiery care arm of Ayushman Bharat, the flagship health programme of the NDA government, under which eligible families are covered for health expenses of up to Rs 5 lakh per year.
From RAN, it is possible to reimburse a maximum of Rs 15 lakh in treatment expenses, and for some time now NHA has been pushing for it to be a sort of supplementary fund to PMJAY so that expensive treatments not covered under the latter scheme can be funded.
In July 2019, NHA CEO Indu Bhushan wrote to the Health secretary, proposing changes in RAN guidelines. “For AB-PMJAY beneficiaries, RAN may be used for services that are not covered under the scheme or in a situation where the family has already exhausted the INR Rs 5 lakh PMJAY cover,” he wrote.
However, the ministry holds that RAN does not have the kind of resources needed to make policy level changes to supplement every patient not covered under PMJAY or has exhausted the family cap. A senior official in the ministry of health said, “There is also the risk of unnecessary procedures if we open up RAN. That is also why we have kept a crowd-funding clause in our rare diseases draft policy. However we will look into Garab’s case and see if relief can be provided.”
Garab is still stuck in limbo. Lobzang Norbo, who accompanied him to Delhi for treatment, said, “We have approached the Health Ministry, we have even tried for support from the PM relief fund but nothing is working. We do not know what to do.”
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