NEW DELHI: Chemotherapy, neonatal procedures, minimal invasive surgeries to open blocked coronary arteries or (PTCA), heart failure and surgeries to remove kidney stones are the top five procedures availed in the last one year by the beneficiaries of the Ayushman Bharat-PM-JAY health insurance scheme.
“People have availed benefits under AB PM-JAY for treatment of various diseases, particularly the ailments which constitute the highest disease burden and economic hardship due to incurring healthcare expenditures,” R S Sharma, the National Health Authority (NHA) Chief Executive Officer, said.
The scheme, billed as the world’s largest government-funded public health insurance scheme, seeks to provide 50 crore beneficiaries with a health cover of Rs 5 lakh per family per year for secondary and tertiary care hospitalisation in both private and government hospitals.
As Cancer deaths and cases are increasing rapidly in India, the top draw for the common people availing the cashless and paperless insurance scheme is chemotherapy. Nearly 7 lakh chemotherapy procedures have been conducted at tertiary care centres under the ambitious flagship government programme. The second most sought-after procedure is neonatal care procedures. Around 1.7 lakh have been done.
Top Tertiary care packages under AB PM-JAY (2021-22)
| SL No. | Procedure | No of preauth | Preauth amount |
| 1 | Chemotherapy procedures | 696579 | 16799400000 |
| 2 | Neonatal care procedures | 178255 | 1363462000 |
| 3 | PTCA | 113833 | 7825600000 |
| 4 | Congestive heart failure (medical management) | 41784 | 540000000 |
| 5 | PCNL (Percutaneous Nephrolithotomy) | 35264 | 1223606900 |
PTCA surgeries, which help in improving blood flow to the heart muscle without open-heart surgery, have been the third highest medical procedure done at the various tertiary healthcare centres that have been authorised under the scheme.
The fourth procedure that is availed by the beneficiaries is congestive heart failure or heart failure procedures, which can sometimes be life-threatening if proper and immediate medical treatment is not provided in time. About 41,000 such medical treatments were provided to people who couldn’t have otherwise been able to access and afford such costly healthcare.
Percutaneous Nephrolithotomy (PCNL), a technique used to remove specific stones in the kidney or upper ureter, was the fifth most surgery – over 35,000 - that was availed by people in the last year.
Sharma also said the procedures relevant to cardiology, oncology, renal diseases, and general medicine, which cover secondary and tertiary care, are some of the top packages.
He added that the other health packages which feature among the top utilised procedures include cataract surgery, caesarean delivery for high-risk pregnant women, severe anaemia and enteric fever or typhoid fever.
The total value of authorised hospital admissions for the top medical and surgical interventions during the previous year is approximately Rs. 4,126 crores in secondary and tertiary care.
During 2021-22, a total of 1.52 crore hospital admissions have been authorised under AB PM-JAY. The total value of such hospital admissions comes to about Rs. 14,957 crores till May 25 this year, Sharma told this newspaper.
“We aim to increase the scope and scale of the scheme. Some states with higher utilisation of these top medical and surgical packages are Kerala, Karnataka, Madhya Pradesh, Gujarat, Uttar Pradesh and Chhattisgarh, among others,” Sharma said.
The NHA head said that at AB PM-JAY, particular emphasis is given to ensuring that beneficiaries can access services at any location, including their residence.
“We have empanelled a network of around 25,000 hospitals across the country. Of these, around 9,000 hospitals are in aspirational districts. Further, under AB PM-JAY, a 10 per cent incentive is provided for all procedures carried out in hospitals located in aspirational districts over and above the base package rates to encourage their participation,” he said.
There are 112 most under-developed districts across the country, and the government aims to quickly and effectively transform these districts to raise people's living standards.
Under the scheme, a network of nearly 25,800 public and private hospitals has been developed, of which 10,700 are private healthcare facilities, whereas 15,100 are public healthcare establishments.
Many states have also relaxed the empanelment criteria in certain districts with inadequate health infrastructure to ensure an adequate number of hospitals for the scheme beneficiaries.
“As the scheme matures, it will help in catalysing investment into healthcare infrastructure in under-served areas by fostering demand for healthcare services from the eligible beneficiaries,” he added.
He added that one could think of AB PM-JAY as an aggregator platform wherein healthcare providers can plug in to serve the needs of beneficiaries and earn a viable income.
Over 18 crore cards have been issued since the launch of the scheme in 2018 till May this year. According to the union health ministry, more than 3 crore 20 lakh people have availed the benefit of hospital facilities, and hospital admission amount to 37 thousand 398 crore rupees till May this year.