West Bengal pulling out of Ayushman Bharat could impact other states too

BL Research Bureau

The government of West Bengal pulling out of Ayushman Bharat has been an unpleasant development for the much-touted health insurance scheme, no doubt. With West Bengal ranking in the top 5 states in terms of hospital empanelments (about 1240 hospitals) under the scheme, its sudden withdrawal could impact its neighbouring states.

Industry players say that a large number of people from Bihar, Jharkhand and Chhattisgarh go to West Bengal (mainly Kolkata) for complicated/tertiary care in the past. Currently under the scheme, portability is allowed and is a key positive. Under this, a beneficiary can go for treatment to other states.

The pulling back of West Bengal from Ayushman Bharat could hence impact some states that have inadequate capacity or infrastructure to handle complex procedures.

Why it pulled out

The government of West Bengal has a health insurance scheme, named ‘Swasthyasathi’, which has been running in the State since the beginning of 2017. In the MoU for the Ayushman Bharat scheme, which was signed between the state and the central governments, it was clearly stipulated that the State would retain the name Swathyasathi. Hence, a the Swathyasathi family card was to be used with reference to the central government’s stipulation of a family card under Ayushman Bharat scheme.

The state communicating its withdrawal from the Ayushman Bharat scheme said that given all these pre-decided stipulations, it is unclear why the Centre unilaterally decided to issue entitlement letter/card directly to the beneficiaries. The letter issued by the Centre carries the name of the scheme as PMJAY with Prime Minister Narendra Modi’s picture and lotus logo of the scheme, in the regional language.

Portability: Vital for success

A critical aspect of Ayushman Bharat is the portability, wherein people can get treatment from other states too, free of cost. For now, states that already had health insurance schemes are doing well, and they have been able to seamlessly integrate their existing health schemes with the Ayushman Bharat. Hence, keeping states such as Gujarat, Chhattisgarh and Tamil Nadu which already had existing health schemes on board will be critical for the success of Ayushman Bharat.

Divyanshu Jha, Deputy Development Commissioner, CEO, Zila Parishad, Ranchi, Jharkhand, however feels that one or two states pulling out will only shift the equilibrium in the interim. “West Bengal pulling out is a concern as there is a large outflow of patients to the State. But once people realise that they will have to shell out for treatment in West Bengal, they will move to other states such as Delhi, Tamil Nadu, Uttar Pradesh etc., and hence getting portability to function smoothly is imperative under the scheme.”

Jharkhand is one of the greenfield states (no health insurance scheme in the past) that has shown good progress under this scheme. Of the total 35,000 claims submitted by Jharkhand under the scheme, about 382 are portable cases — beneficiaries of Jharkhand getting treatment outside the State. While these do not include number of people getting treatment done in West Bengal, they indicate the flow of people to other states for various treatments due to lack of requisite infrastructure to handle critical/tertiary procedures.

According to Divyanshu Jha, national portability is imperative. “Given that in Jharkhand internal capacities for higher sophisticated procedures is less, patients who access services outside the State are substantial and hence we are actively working to resolve the issue of acceptance of our state beneficiaries in other states under Ayushman Bharat. The transaction management system (TMS) within the State is different from that outside the State. The integration of the two is imperative. We are moving in that direction.”

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