According to people familiar with the matter, the government is considering allowing Central Government Health Scheme (CGHS) beneficiaries to seek treatment at hospitals affiliated with the flagship Ayushman Bharat-Pradhan Mantri Jan Arogya Yojna (AB-PMJAY).
It is being planned that the beneficiaries of the CGHS scheme can also seek treatment at any of the hospitals across the country empanelled under the Ayushman Bharat-Pradhan Mantri Jan Arogya Yojna. It will ensure patients have a larger ambit of hospitals to choose from, especially those patients who are looking for super speciality treatment,” said a senior government functionary aware of the matter, requesting anonymity.
The government runs two separate health insurance schemes, CGHS and AB-PMJAY.
The CGHS primarily serves Central Government employees, both active and retired. The scheme has nearly 4.1 million registered beneficiaries, and 2,000 hospitals and diagnostic centres have been empanelled across the country. The distribution of hospitals is somewhat uneven, with larger cities having more hospitals than tier 2-3 cities.
By offering the option of getting treated at AB-PMJAY hospitals, the ambit would increase for beneficiaries,” said the government functionary cited above.
AB-PMJAY has at least 107.4 million beneficiaries, and until last month, approximately 37.5 million hospital admissions totalling approximately 45,000 crores were authorised through a network of 25,000 empanelled health care providers.
Several changes are in the works for the current public health insurance schemes, including a unified card for AB-PMJAY and schemes run by individual states, according to Union Health Minister Mansukh Mandaviya at a select briefing last month.
“It will be a unified card called Ayushman Card.” We have essentially done co-branding, which allows beneficiaries to use treatment packages from both the Central and state-run health insurance schemes with a single card. Many states have their health insurance schemes, and beneficiaries were often perplexed about empanelled hospitals, implementation support agencies, insurance companies, and third-party administrators. “There will now be a common name,” Mandaviya predicted.
According to the Union Health Ministry, several states are currently running close to 20 schemes.
According to officials in the health ministry, the government is in the process of creating new cards with the Central and state government logos and the words ‘Ayushman Bharat Pradhan Mantri Jan Arogya Yojna-MukhyaMantri Yojna’ imprinted on them to represent the unification.
As part of the new arrangement, eligible beneficiaries of any government insurance scheme will be able to seek treatment at any of the central scheme’s 25,000 empanelled hospitals.
Even though it is not legally required for states to implement the changes, all states, except Delhi, Odisha, and West Bengal, have agreed to implement the proposed changes, according to an official.
The idea of expanding Ayuhsman Bharat empanelled hospitals to CGHS beneficiaries is good as these will be private hospitals offering multi-speciality care. The options will widen, which is a good thing.,” said Dr MC Misra, former director, All India Institute of Medical Sciences, Delhi.
“However, it will be better if the cashless benefit that Ayushman Bharat beneficiaries get is also be extended to CGHS beneficiaries,” he added.