A State Health Authority (SHA) has been set up to implement Ayushman Bharat-Pradhan Mantri Jan Arogya Yojana in Bengal as the state’s flagship universal health coverage scheme, for which finance minister Swapan Dasgupta proposed a ₹3,100 crore outlay in the Bengal budget on Monday.
Approximately 7 crore people are expected to be covered under Ayushman Bharat, explicitly including ASHA and ICDS workers and all citizens above 70 years of age, according to the proposal.
“Poor households not covered under Ayushman Bharat guidelines would be supported through the chief minister’s relief fund for medical expenses,” a state government official later said.
Ayushman Bharat provides coverage of ₹5 lakh per family per year for hospital care.
“The SHA, in line with the National Health Authority, will manage the day-to-day administration of the Ayushman Bharat scheme. The office has been set up at Swasthya Bhavan, and officials will conduct training of private hospital personnel for smooth implementation of Ayushman Bharat,” said the official.
The SHA will verify the eligibility of families and issue Ayushman cards, partner with private hospitals for cashless services, and conduct audits. It will also settle claims made by empanelled hospitals and resolve complaints.
Several private hospitals said Ayushman Bharat would be implemented from July, but also expressed apprehension over timely reimbursement. They also said there was confusion over whether Mamata Banerjee’s Swasthya Sathi scheme would be integrated with Ayushman Bharat.
“The issue is still undecided. However, we are still reimbursing private hospitals that submit claims under Swasthya Sathi,” said a health department official.
Swasthya Sathi was launched by Mamata Banerjee on December 30, 2016. A state-level implementation committee under the chairmanship of the chief secretary was formed to oversee the scheme. According to the Swasthya Sathi website, 2.42 crore families are covered under the scheme.
“We have heard that the reimbursement period is longer compared to Swasthya Sathi. We hope the newly formed SHA will address the reimbursement issues,” said the CEO of a private hospital.
“We hope that the reimbursement process for Ayushman Bharat will be fast and smooth so we are able to serve more patients. We are planning to take patients under the Ayushman Bharat scheme within a month and are expecting patients from other states also,” said Rupak Barua, president, Association of Hospitals of Eastern India.
According to sources, hospitals must fill out a detailed form to register for Ayushman Bharat. Once approved, they receive a unique ID.
They must then register the names and details of doctors and nurses, with Aadhaar linkage required under the scheme.
The CEO of a private hospital said doctors at the healthcare institute are now being empanelled. “Once empanelment is complete, we will be ready to accept patients. It will take about a month to complete the procedure,” he said.
After the new government’s first cabinet meeting at Nabanna, chief minister Suvendu Adhikari had announced: “Honourable Prime Minister Narendra Modi had said that Bengal would be linked to Ayushman Bharat after the first cabinet meeting (of the new government). The chief secretary, health secretary and advisers in the chief minister’s office will formalise the necessary agreements with the Union health ministry as soon as possible.”
“We will create a paperless office and update every portal. The direct benefit transfer will continue under the leadership of Prime Minister Modi. But everything will be done with complete transparency,” he had said.
