HT Business: September 14, 2018
Among the 16 states piloting Ayushman Bharat before its September 23 launch, Meghalaya has universalised the Rs 5 lakh annual hospitalisation coverage under the national health protection scheme in the state.
The state increased the cover to Rs 5 lakh by allocating an additional Rs 40 crore to its universal insurance scheme, under the Megha Health Insurance Scheme (MHIS), Rs 2.8 lakh annual cover was being provided to all families in Meghalaya.
“As Meghalaya is a hilly state, it will get 90% central assistance for the poor and vulnerable as identified by the Socio-Economic Caste Census (SECC). Since the state already spends Rs 60 crore on MHIS, we decided to raise the budget to Rs 100 crore and expand the new scheme,” said Meghalaya health minister A L Hek.
Hek said the health insurance coverage in Meghalaya is higher—over 50% — than the national average of 27% according to the National Health Profile 2017.
Of the state’s 880,000 families, 80,000 were covered under the government employees’ health scheme. As many as 354,000 poor households have been selected for the Centre’s assistance.
For MK Syiemiang, the increased hospitalisation cover means he may not have to pay anything for his brother’s cancer treatment. He considers himself lucky to have registered for MHIS in July last year. Just after he received the MHIS smartcard, his brother, David Mana, 42, was diagnosed with throat cancer.
Mana does not need to pay for medicines, including the Rs 5,000 chemotherapy drug. He pays a nominal fee for the tests and the money is reimbursed to him. Since he lives about 8 km from the Shillong Civil Hospital, where he is undergoing treatment, he gets Rs 200 allowance to travel for treatment.
Meghalaya has adopted the insurance model of paying for services and is in the process of finalising the implementation of the new policy. Once that is done, an insurer can enrol beneficiaries and upload the data to a centralised database.
“We had a data collection drive to identify SECC beneficiaries and the list was further updated with the help of Ashas (village-level accredited social health activists). For the registration process, however, we need an internet connection but connectivity is a real issue in most parts of the state,” said a Meghalaya health department official on condition of anonymity.
The state has begun testing the new software to update patient information real-time to the central database.
But for an operator doing it using a laptop and a dongle, it is tough. Updating each record takes over 20 minutes and the data keeps getting lost midway because the system hangs.
At the next window, the operator filing the claims of the MHIS patients has no such problems because the software has an offline version.
“We update the patients’ details to the local database and upload it when the internet is back. Alternatively, we carry the data in a pen-drive or a CD and upload it from a cyber cafe,” said the MHIS operator, who did not want to be named. The new software has benefits. Being a national scheme, it can be accessed from all states and insurers, who can then approve the claims online. “The flowchart for registering a claim is much better and a patient’s photograph is taken at every stage to rule out mismatch in claims,” said Steven Bareh, an officer at the State Nodal Agency for MHIS.
The government meets around 90% of the state’s health care needs in Meghalaya. To meet the shortfall of health services, Meghalaya is considering empanelling its 109 primary health centres under Ayushman Bharat that offers cover for secondary and tertiary care only in community centres, district hospitals, medical colleges and empanelled private hospitals. “In Meghalaya, the topography is such that travelling to the nearest hospital can be a challenge,” said state health secretary and Ayushman Bharat chief operating officer Pravin Bakshi. “Enrolling PHCs (public health centres) will ensure everyone receives the benefits of the health services. So, we have written to the central government,” said Bakshi.
“The best thing about this national health insurance scheme is that it is flexible and the states can modify it according to their own needs. If the PHCs in Meghalaya have a doctor and 24x7 emergency care, it makes sound ground for them to implement the medical packages in PHCs and we will agree,” said Ayushman Bharat deputy CEO Dr Dinesh Arora.
“It is an evolving scheme and all the states will have different mechanisms for implementing and we will be able to learn from the best practices. Just like the Meghalaya government will be providing stand-alone diagnostic tests.”.
The new scheme will also cover tertiary care in other states.
“One of the best things about the scheme is the portability,” said Arora. “This will be a single health insurance scheme across the country and people can avail of the benefits in any state without worrying about the insurance cover,” he said.
First Published: Sep 14, 2018 07:25 IST
Disclaimer: This information has been collected through secondary research and IBEF is not responsible for any errors in the same.