Ayushman Bharat beneficiaries not covered under various packages of the insurance programme and requiring high-cost treatment will be able to get financial assistance of up to Rs 15 lakh under the Rashtriya Arogya Nidhi (RAN) scheme, an office memorandum said.
The Union Health ministry has issued revised guidelines of the umbrella scheme of RAN in the wake of complaints that poor patients suffering from life-threatening diseases have not been able to avail treatment under it if they are beneficiaries of the Ayushman Bharat - Pradhan Mantri Jan Arogya Yojna (AB-PMJAY).
The memorandum has been sent to all government hospitals, all regional cancer centres, health secretaries of all states, department of expenditure and the National Health Authority (NHA), the apex body implementing the insurance scheme.
"If as per the medical advice, the suggested treatment is not covered under any of the approved listed packages of AB-PMJAY, financial assistance up to Rs 15 lakh can be provided to AB-PMJAY beneficiaries out of umbrella scheme of RAN," the office memorandum with the revised guidelines stated.
In such a situation the beneficiary will get certified from the respective government hospital that his or her condition is not covered under the AB-PMJAY and thus the patient should be allowed to avail financial assistance under RAN, the memorandum stated.
The All India Institute of Medical Sciences and the NHA had written to the Health Ministry suggesting patients deprived treatment under AB-PMJAY could be covered in the RAN umbrella scheme.
They drew the ministry's attention to cases of patients, who were refused under PMJAY as they were suffering from ailments such as blood cancer, chronic liver disease and required organ and bone marrow transplants which do not figure among the 1,393 medical packages mentioned under the scheme.
Earlier, in November the Health Ministry had rejected their proposal and rather had suggested the NHA to consider inclusion of transplantation of organs under procedures covered under PM-JAY and also enhancing the ceiling of Rs 5 lakh per annum so that patients eligible under PM-JAY may avail facilities under the programme only.
The National Human Rights Commission recently had sought a report from the Health Ministry over a complaint about patients holding BPL cards not getting RAN benefits if they availed benefits of AB-PMJAY even if they are suffering from life-threatening diseases whose expenditure is much more than Rs 5 lakh, the maximum permissible limit under Ayushman Bharat scheme.
Hailing the recent amendments in the guidelines, Dr Vijay Gurjar, a faculty at AIIMS, said several poor patients requiring kidney transplant, bone marrow or liver transplant are suffering and facing problems in getting treatment as they are PMJAY card holders.
Their treatment cost is more than Rs 5 lakh but they are not able to avail benefits under the RAN scheme.
"All welfare policies are meant for benefiting poor people so they should be reviewed from time to time if they are not serving the sole purpose.
"Policy makers and bureaucracy should be empathetic towards its beneficiaries. Being responsible doctors we also should be vigilant about these things," Gurjar said.
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