Exclusive | Fully prepared for rollout with 31 states, 9,000 private hospitals on board: Ayushman Bharat CEO

The National Health Agency (NHA), the implementing body of Prime Minister Narendra Modi's signature scheme Pradhan Mantri Jan Arogya Yojana (PM-JAY) or Ayushman Bharat, said it's fully prepared for the launch of the scheme across 26 states and 450 districts on September 23

"We are fully prepared, it's a big scheme, there is no start or end point, it's a continuum," said Indu Bhushan, Chief Executive Officer (CEO) of Pradhan Mantri Jan Arogya Yojana (PM-JAY) and NHA, in a telephonic interview to Moneycontrol.

"We will continue to deepen the scheme in terms of capacity, in terms of number of hospitals, in terms of awareness. It will take some time before it becomes mainstream," Bhushan added.

Ayushman Bharat, popularly known as ModiCare, aims to provide Rs 5 lakh coverage to 10 crore poor families or nearly half a billion people and is considered an important scheme politically for Narendra Modi to showcase to voters as he heads for the general elections next year.

The scheme will cover medical and hospitalization expenses for almost all secondary care and most of tertiary care procedures. PM-JAY has defined 1,350 medical packages covering surgery, medical and daycare treatments including medicines, diagnostics and transport.

31 states on board

Bhushan said 31 states have so far signed memorandums of understanding (MoUs) with the Centre, and 26 of them, including all BJP-ruled states, will be rolling out the scheme on September 23.

Bhushan added that majority of the states who are following the trust-based model have completed the critical work of forming trusts and hiring third-party agencies to implement the scheme.In a trust-based model, each individual state will form its own trust to manage the scheme and claims will be disbursed from a corpus created from central and state government contributions.

Congress-JDS ruled Karnataka, which was dilly-dallying on whether to join the scheme or not, finally came on board on Friday.

Five states who have opted out of the scheme are Punjab, Delhi, Kerala, Telangana and Odisha.

These states already have an existing healthcare insurance scheme and they don't see any urgency to sign up with the Centre. Also with the coverage going up under the PM-JAY scheme, these states are worried about the financial implication. The cost of the scheme will be shared between the Centre and states in a 60:40 ratio.

9,000 hospitals and counting

On getting private hospitals on board, Bhushan said NHA has made quite a progress.

"So far, nearly 9,000 private hospitals have got empanelled in the scheme, and another 3,000 applications are pending with the agency. We will clear them in the days to come," Bhushan said.Bhushan added that large hospital chains like Medanta have joined the scheme, while Apollo Hospitals and Narayana Health expressed interest and will soon be part of the scheme.

Bhushan said with Tamil Nadu and Karnataka signing MoUs, "we expect Apollo and Narayana Health to be part of the scheme, as both the hospital chains are part of the respective states' health assurance schemes".

As over 70 percent of healthcare in India is provided by private hospitals, getting participation from these hospitals is critical to the success of Ayushman Bharat.

Large private hospital chains haven't been very keen on joining the scheme citing the proposed reimbursement package rates as unscientific, arbitrary and insufficient.

Apollo Hospitals and Fortis Healthcare have indicated that they were negotiating with the government to review the package rates.

Moneycontrol earlier reported that the Centre has initiated cost studies of 1,350 medical procedures covered under the scheme and assured private hospitals that rates will be revised, if they were found to be too low based on the outcome of cost studies.