Chhattisgarh ensures health insurance benefits to entire population

Team INCLUSION
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Chhattisgarh has been a focus state under Ayushman Bharat scheme. The first phase of the scheme, that targets to open 1.5 lakh Health and Wellness Centres by 2022 across the country, was inaugurated in the tribal dominated Bijapur district of Chhattisgarh. TEAM INCLUSION analyses the journey of Ayushman Bharat scheme in the state

Chhattisgarh is among the top performing states in the implementation of Ayushman Bharat scheme. The state has effectively implemented the Ayushman Bharat scheme that covers the deprived section of the society. There is also a state specific scheme that ensures that the entire population of the state is provided with health insurance benefits. 
 
Chhattisgarh has implemented the Ayushman Bharat scheme through a hybrid model. Besides the Ayushman Bharat - Pradhan Mantri Jan Arogya Yojana (AB-PMJAY), there is a state specific scheme named Mukhya Mantri Swasthya Yojana (MMSY) and Sanjeevani Sahayata Kosh (SSK). Under the AB-PMJAY scheme 42.3 lakh households are covered, while another 19.1 lakh families are covered under MMSY. This takes the number of households covered under the two major health insurance scheme to 61.4 lakh. Rest of the population is covered under SSK scheme.
 
Beneficiaries covered under the AB-PMJAY scheme get health insurance coverage of Rs 5 lakh per household per year. This scheme is for the deprived categories such as families with only one room with kuchha walls and kuchha roof, no adult member between age 16 to 59, landless households deriving major part of their income from manual casual labour, families without shelter, destitute living on alms, manual scavengers etc. Rest of the households (those households who are not covered under the AB-PMJAY) get upto Rs 3 lakh health insurance cover. Treatments are provided at all public hospitals as well as empanelled private hospitals.
 
First Health and Wellness Centre
The first Health and Wellness Centre under the Ayushman Bharat scheme was launched in Chhattisgarh on 14 April 2018, over five months before the formal launch of the health insurance programme. Prime Minister Narendra Modi chose to inaugurate the first part of the scheme that focuses on primary healthcare to mark the birth anniversary of B R Ambedkar. 
 
Health and Wellness Centre is an important part of the Ayushman Bharat scheme. The government has set a target to set up 1.5 lakh Health and Wellness Centre across the country by 2022. 
 
“The goal of the government is to complete this work by 2022. You can imagine the magnitude of the work. By the time the country will be celebrating 75 years of Independence, a network of Health and Wellness centres will already be in place across the country. Priority will be given to those 115 districts, which are still behind in the race towards development,” Modi had said after inaugurating the first Health and Wellness Centre at tribal dominated Bijapur district of Chhattisgarh. This underscores the importance of deprived region and section of the society given in the Ayushman Bharat scheme. 
 
Chhattisgarh has emerged as among the top performing states in implementation of Ayushman Bharat scheme. In the state-wise metrics prepared by the National Health Authority (NHA), Chhattisgarh is the fourth best performing states. Only Gujarat, Kerala and Andhra Pradesh are ahead. In fact, in terms of the number of beneficiaries Chhattisgarh is the top performer. In the first eight months over 500,000 people benefited from the scheme in Chhattisgarh. 
 
Every year more than 6 lakh beneficiaries receive healthcare services through the universal insurance coverage umbrella in the state. These services include secondary care as well as tertiary care. More than 600 private hospitals and 700 public hospitals are empanelled to provide the health services under the schemes, as per the data available with the Department of Health and Family Welfare, Chhattisgarh.
 
A unique number has been provided to each family in the state for cashless and paperless access at the empanelled hospitals. Each hospital has been equipped with system and Transaction Management System to read the beneficiary Identification card and to provide services.
 
One Arogya Mitra is placed in each hospital to support the beneficiaries and coordinate with hospital for healthcare services. It took some time for hospitals to understand the services delivery of the new system but slowly it picked up. Average claim amount per month is around 70,000 amounting Rs 55 crore. 
 
Chhattisgarh has introduced several measures to ensure better experience for the beneficiaries as well as the health service providers. Turnaround Time (TAT), the time interval from the time of submission of a process to the time of the completion of the process, is maintained at 7-days. The claim is settled timely even with challenges like failure of documentation upload from hospitals and support them technically through training. 
 
Claim settlements are well monitored and made after following the due procedure like taking queries, availability of doctors, verification of documents through field officers and if the claim is genuine it is not rejected in any case. Regular DGRC/SGRC meetings are held for reviewing claims and thus transparency is maintained. Proper attendance marking system has been implemented. Centralised medical helpline number that is complaint grievances number is provided to handle the complaints of customers and feedback system is in place in order to monitor the treatment service provided from the hospitals.
 
Public Hospital Infrastructure
The health insurance schemes have led to significant improvements in the condition of public hospitals. They are continiously investing in upgradation of infrastructure. Following measures have helped improve the condition of public hospitals:
  • Timely payment of CMHDF fund to ensure that adequate fund is available to upgrade public hospitals.
  • Drives in public hospitals for claims submission and documents verification to ensure payments.
  • Adequate IT infra process.
  • Monitoring DGRC to ensure timely grievance resolution & build confidence.
  • TAT for payments- 90 per cent payments done in less than 15 days.
  • Dedicated helpline for medical queries.
     
Relaxed Norms for Wider Coverage
The state has relaxed several norms in order to ensure wider coverage of the scheme. The hospital empanelment criteria has been significantly eased. Requirements of bed strength for multispecialty hospital has been reduced from 50 beds to 20 beds. There is relaxation in documentation for Public hospitals. Special drives have been launched for helping in claim submission and documentation by public hospitals. 
 
To ensure penetration of scheme, enhance participation of hospitals in the scheme in remote areas and cater to the dearth of doctors in the state, all hospitals have been allowed to get surgeries done by MBBS doctors (other than tertiary care procedures). All hospitals have also been allowed to do basic surgeries irrespective of specialty.
 
Monitoring
Apart from following the National Health Authority guidelines, Chhattisgarh government has put in place extra measures to ensure effective and corruption free implementation of the scheme. Three state level joint meetings of SNA, ADC, RHICL team have been conducted so far for building mutual confidence and resolve queries and bottlenecks from the scheme. Daily performance analyses and corrective measures taken for shortfall.
 
Weekly and monthly reviews are conducted for Claims Team, District and Divisional managers. An independent audit function has been set up to monitor compliances, process adherence and quality. Fortnightly project review meeting is being done with key management personnel.
 
Impact and Way Forward
These schemes have helped the state in bringing down infant mortality rate and maternal mortality rate. The out-of-pocket spending on healthcare has come down significantly in the state. It has helped improve the health infrastructure in the state. A large number of hospitals have come up in remote rural areas. Fees for the treatments and procedures are pre-determined. It is the same for all the hospitals. It encourages the private entities to set up hospitals in rural areas where land, human resource and other costs are lower. 
 
Chhattisgarh government has outlined a comprehensive plan of moving towards Universal Health Coverage through single scheme. In order to attract the central fund the state has successfully co-branded PMJAY with State Schemes. The state government has set a target to provide Unique Number for each family and individual in order to ensure universal health coverage.

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