COVID-19 treatment under Ayushman Bharat – 7.08 lakh claims, 43% approved, 29% amount paid
Sai Krishna Muthyanolla
August 3, 2021
As per the data provided by government in response to a RTI application, a total of 7.08 lakh claims for Rs. 2526 crores were raised for COVID-19 treatment under Ayushman Bharat as of 23 July 2021. Out of these, 3.06 lakh claims have been paid amounting to Rs. 721 crores.
The burden of Health Expenditure is one of the direct impacts of the COVID-19 pandemic. Globally, many countries have responded to this by providing health care support to their citizens suffering due to COVID-19.
The Government of India has also extended healthcare treatment support to the economically weaker sections of the society who are impacted by COVID-19. This is done under the aegis of its Ayushman Bharat scheme, also referred to as Pradhan Mantri Jan Arogya Yojana (PM-JAY). Prior to this, few of the State governments had already included COVID-19 as part of their state-level healthcare schemes. Many of these schemes are in conjunction with the Ayushman Bharat scheme.
In an earlier story, we have highlighted that there is an increase in the public expenditure on healthcare due to COVID-19 pandemic in the country. In this story, we look at the numbers relating to claims for COVID-19 treatment under Ayushman Bharat Scheme. This is based on the data provided by the Ministry of Health & Family Welfare in response to a Right to Information Application (RTI).
Both Testing & Treatment of COVID-19 covered for those eligible under Ayushman Bharat
At the beginning of the first wave of COVID-19 pandemic in the country, the government of India decided to include COVID-19 as part of Ayushman Bharat Pradhan Mantri – Jan Arogya Yojana. Accordingly, the National Health Authority has notified two packages:
In view of the various symptoms and co-morbidities that are associated with COVID-19, the coverage for treatment is done under various health packages (HBP) already available under PM-JAY.
Apart from these packages, the empanelled hospitals are given the flexibility of including other approved packages based on the symptoms & treatment provided. The State governments are required to determine the limit on the additional costs incurred for treatment like isolation facilities, PPE kits, etc.
At the time of inclusion of COVID-19 treatment under Ayushman Bharat, all but 4 states (Delhi, Odisha, Telangana & West Bengal) were part of the Ayushman Bharath PM-JAY scheme. The scheme was subsequently rolled out in Telangana in May 2021. Therefore, the claims for COVID-19 treatment in these states can be raised under the packages mentioned in HBP 1.0 & HBP 2.0. Individual states can set specific cut-off limits.
Most COVID-19 claims raised in Andhra Pradesh followed by Karnataka & Maharashtra
As per the information provided by National Health Authority (NHA) in response to an RTI application, around 7.08 lakh COVID-19 treatment-related claims were raised under PM-JAY across India as of 23 July 2021.
Among these, the highest number of claims are from Andhra Pradesh with more than 1.9 lakh. Karnataka accounted for the second-highest number of claims raised with 1.72 lakhs followed by Maharashtra with 1.49 lakh claims. Around 80 thousand claims came from Kerala. It ought to be noted that these states are among the severely affected by COVID-19 both during the first wave & second wave of the COVID-19 pandemic.
As per the data, out of the 32 states/UTs with beneficiaries under PM-JAY, the claims were raised in 24 of them. Not a single COVID-19 treatment-related claim was raised in a few of the larger states like Bihar, Gujarat & Punjab. However, a news report quoting the government of Punjab states that there are COVID-19 patients who have benefitted from the PM-JAY scheme in the state.
Out of the total claims raised, only 43% of the claims have been paid as of 23 July 2021.  Among the states, most claims were paid in Karnataka with 95.6 thousand i.e., around 55 % of the claims raised. A lower proportion of claims have been paid in other states with a high number of claims raised. Around 45% of the raised claims were paid in Andhra Pradesh while in case of Maharashtra it is only around 39%. Only around 20% of the claims raised have been paid in Kerala & Chhattisgarh.
Only about 29% of the Claim amount raised has been paid
The total amount raised through claims for COVID-19 treatment under PM-JAY across the country is about Rs. Rs. 2.52 thousand crores as of 23 July 2021. This accounts for an average of around Rs. 35,600 per claim. Out of the total amount, only around Rs. 721.23 crores have been paid which is around 29% of the total claim amount.
A total of five States account for 95% of the total amount. Karnataka accounts for the highest with around Rs. 830 crores, followed by Andhra Pradesh with Rs. 612 crores. Maharashtra, Tamil Nadu & Kerala make up the rest of 95% of the total claims amount raised. Tamil Nadu has the highest amount per claim raised with Rs. 1.31 lakh per claim.
However, only 29% of the claim amount that is raised for treatment of COVID-19 is paid on average across the country.  Among these five states noted above, more than half of the claim amount raised has been paid only in Tamil Nadu with around 54%. In Karnataka & Maharashtra, around 37% of the claims’ raised amount has been paid while in Kerala it is only 11%.
As per the RTI data, the value of claims paid in Andhra Pradesh is Rs. 1.78 crores. This accounts for only 0.3% of the total amount raised. This percentage is an anomaly compared to the trend across other states. Hence, we have reached out to the Health Department of the Government of Andhra Pradesh for clarification and if the numbers provided by the Union Health Ministry are right. This article will be updated once a response is received.
Huge disparities among states in the utilization of the Ayushman Bharat Scheme for COVID-19 treatment
As per the data available on the PM-JAY website, U.P & Bihar have the highest number of households enlisted as beneficiaries under Ayushman Bharat with 1.16 & 1.08 crore households respectively. Uttar Pradesh has so far reported 17.6 lakh COVID-19 cases and Bihar around 7.4 lakh cases. However, only about 900 claims have been raised in Uttar Pradesh for COVID-19 treatment, while not a single claim is raised in Bihar.
On the other hand, more than 90% of the claims for COVID-19 treatment have been raised from Karnataka, Andhra Pradesh, Maharashtra, Tamil Nadu, Chhattisgarh & Kerala. These 6 states contribute 94% of the total number of claims and 97% of the number of claims raised, highlighting huge disparities among the states in utilizing COVID-19 treatment benefits under Ayushman Bharat.
Apart from the disparities among states, another key aspect is the lower proportion of claims approved. At the national level, only 43% of the claims raised have been approved. Even this number is mainly due to the claims approved in Tamil Nadu & Karnataka.
The claims’ paid amount is still lower at 29%. Since the age of the claims is not known, it is difficult to ascertain the pendency of claims. However, the huge disparities among states in both the number of claims & amount raise questions around the efficacy of COVID-19 treatment under PM-JAY, at a time when the country is arguably facing its biggest health crisis.
Featured Image: COVID-19 treatment under Ayushman Bharat