Health Scheme Challenges
All seem to be not well with two ambitious public health insurance schemes -- Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB PM-JAY) and Chief Minister's Health Insurance Scheme (CMHIS)
- All seem to be not well with two ambitious public health
insurance schemes -- Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB
PM-JAY) and Chief Minister's Health Insurance Scheme (CMHIS) – in Nagaland on
the implementation front, as allegations of irregularities in the settlement of
claims and selection of beneficiaries have hit the headlines. Responding to
unstarred questions posed on February 7 in the ongoing Budget Session, Union
Minister of Health and Family Welfare JP Nadda revealed that a total of 25
hospitals in Nagaland -- both private and government -- have been de-empanelled
under AB PM-JAY due to irregularities from 2018 to February 1, 2025. According
to the National Health Authority guideline, hospitals that fail to meet the
necessary criteria or indulge in wrongful acts during treatment can face
de-empanelment. This came days after the Chief Executive Officer of the
Nagaland Health Protection Society (NHPS) warned hospitals empanelled under the
Chief Minister's Health Insurance Scheme (CMHIS) not to deny treatment to
beneficiaries, citing allegations of hospitals engaging in
"handpicking" beneficiaries. He added that hospitals engaging in such
acts, in violation of the signed MoU, would face de-empanelment after serving a
show-cause notice. However, things have taken an interesting turn, in fact a
confusing one, with the Nagaland Private Doctors’ Association (NPDA)
threatening to suspend the AB PM-JAY and CMHIS services in the state’s private
hospitals starting February 15 “until all pending claims are settled”. The
association has claimed that the NHPS and Future Generali Insurance (FGI) have
failed to honour the terms of the MoU.
- Unfortunately, it is the general public, especially the
marginalised and vulnerable, who stand to lose in the melee. The AB PM-JAY has
expanded since it was launched in 2018, now covering senior citizens over 70
years, but its penetration into smaller cities and towns is still low. The
CMHIS, which was launched by the government of Nagaland in 2022, fills this gap
by covering the population who are not beneficiaries under AB PM-JAY or any
publicly funded insurance scheme. These schemes have no doubt transformed the
healthcare landscape by preventing impoverishment due to hospitalisation and
making quality medical treatment accessible to all. Glitches, if there are any,
which are bound to happen in schemes of such magnitude, should be resolved.
While the implementing agencies should ensure timely settlement of financial
matters, the empanelled hospitals should not engage in exploitation of
patients, as claimed by insurance companies. The concerned authorities should
ensure seamless delivery of health services by nipping attempts to paralyse
these schemes in the bud. It will be too costly to take away the little health
protection the citizens currently enjoy.
