JAMMU: The government of Jammu and Kashmir empowers every family of J&K with a financial protection of Rs 5 lakh annually for meeting catastrophic health expenditure under world’s largest health insurance schemes ‘Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB PM-JAY) and AB PM-JAY SEHAT’.
Pertinently, Jammu and Kashmir was one of the first states/UTs to universalize AB PM-JAY. Under the scheme, 2295 procedures have been covered, out of which, some procedures have been reserved for public hospitals like psychiatric and maternity procedures including Hysterectomy (Uterus removal) etc.
So far, under AB PM-JAY and AB PM-JAY SEHAT more than 7 lakh treatments have been provided to J&K domiciles including treatments received outside J&K using portability option and the treatments amounting more than Rs. 1100 crore. On an average, the daily claim outgo is about Rs. 2 crore now. Every 10 in-patients are being provided with a facilitator by the name of Pradhan Mantri Arogya Mitra (PMAM) across all the empanelled health-care facilities of the Union Territory and there are about 425 such PMAMs working in Public Healthcare facilities.
Significantly, Health and Medical Education department through its 104 Call Centres has contacted 21145 beneficiaries during the last six months. Out of which, 58 per cent have rated the services provided under AB PM-JAY/ SEHAT as excellent, 41 per cent have rated the services as good while only 1 per cent have rated the services as poor. Besides, State Anti Fraud Unit (SAFU) has conducted audit of all the 226 cases who have rated the services as poor.
On the basis of feedback of beneficiaries, grievances received on CGRMS, CPGRAMS, JKIGRMS, feedback of Insurance Company and triggers received from National Anti fraud Unit (NAFU) of National Health Authority (NHA) and strictly as per the guidelines issued by NHA, the State Health Agency (SHA) has conducted audit of 100 per cent claims preferred by Empanelled Private Hospitals. So far, more than 60,000 cases have been audited during the current policy period. On the basis of the audit, SHA has imposed Rs. 3.06 crore as penalty on erring empanelled healthcare providers and suspended 15 empanelled healthcare providers for violating standard treatment guidelines and for other malpractices.
Besides, capacity building programs are being conducted by NHA and SHA wherein PMAMs, District Implementation Units (DIUs) and other stakeholders are being regularly trained. Likewise, regular IEC activities are being done by SHA for educating and informing the public about different aspects of the scheme.
There is a dedicated National and UT level helpline for the beneficiaries who are being facilitated throughout the process of treatment. The general public or prospective beneficiary patients have been requested to contact SHA in case of any grievance through 104 Call Centre, QR Code Scan (available at Ayushman kiosk at all the EHCPs), Helpline Numbers 18002335554 and 18002034138 besides Whatsapp Helpline Number 9906241592.
