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NHRC seeks answers on high-cost treatment and Ayushman Bharat

The Prime Minister and the Union Ministry of Health and Family Welfare praised the Government’s flagship health insurance scheme Ayushman Bharat in the last days of December. However, concerns have been raised about the scheme by the National Human Rights Council (NHRC) – in particular over complaints that Ayushman Bharat beneficiaries are struggling to access high-cost treatments provided under a separate scheme.

The Rashtriya Arogya Nidhi (RAN), as explained by the Union Health Ministry, “provides for financial assistance to patients, living below [the] poverty line and who is suffering from major life threatening diseases, to receive medical treatment at any of the super-specialty government hospitals/institutes.” However, the NHRC has received notice that some Ayushman Bharat beneficiaries are being denied treatment under the RAN if they are already availing benefits under the former initiative, which allows for expenditures to be covered up to Rs 5 lakh per family per year. However, certain treatments are not covered under Ayushman Bharat – and if patients wish to turn to RAN, which provides cover of up to Rs 15 lakh for severe conditions, availing Ayushman Bharat can result in their being turned away. 

“The complainant has…stated that due to such discrepancies people belonging to the most marginalised section of society are forced to sell their houses, land and to take loan on higher interest rates to cover the cost of treatment,” the NHRC wrote to the Union Health Ministry. “He has requested the Commission to ask the government to take immediate necessary action so that poor patients get the benefit of the RAN scheme and Ayushman Bharat health scheme in case of life-threatening diseases, when the expenditure exceeds Rs 5 lakh permitted under the PMJAY scheme.” 

Such a measure is already being considered by the Union Health Ministry according to reports. This would raise the ceiling on the cost of expenditure permitted for those with conditions necessitating treatment likely to exceed the Rs 5 lakh cost. 

The controversy over the discrepancy between RAN and Ayushman Bharat has arisen in recent weeks. “The job of the government is to help and not find the loopholes. Government orders cannot supersede the spirit behind the schemes,” wrote Dr K. K. Agarwal, president of the Confederation of Medical Associations of Asia and Oceania and the Heart Care Foundation of India. “Its like that the rules cannot supersede the act…where should a poor man go for the clarifications? Courts are already overloaded with cases. Everyone cannot afford the courts also. Such powers should be given to district magistrate or the CMO [chief medical officer] to handle and interpret the government orders in the right spirit.” 

Agarwal took cognisance of a report published in The Times of India. “Twelve-year-old Sameer from Bihar’s Muzaffarpur district is suffering from aplastic anaemia, and needs Rs 12 lakh for a bone marrow transplant,” read the report by Rema Nagarajan. “You would think that’s not a big hurdle since his mother’s name figures in the list of Ayushman Bharat beneficiaries but unfortunately his condition isn’t covered by the scheme. 

“What’s even more unfortunate for the family, which is paying through its nose for weekly platelet transfusions, is that though Sameer is eligible for treatment under RAN…he can’t be treated because a government order stipulates that anybody covered under [Ayushman Bharat] cannot be provided funds under RAN.” 

The NHRC is seeking an action-taken report from the Union Health Ministry concerning this matter.

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