Govt starts process for implementation of JK Universal Health Scheme

Govind Sharma

JAMMU, July 6: After a long wait of over three months, Government has set into motion the process for implementation of Jammu Kashmir Health Scheme (JKHS) under which free of cost Universal Health Coverage will be provided to all residents of the Union Territory in convergence with Ayushman Bharat-PMJAY.
In a major relief to the people of Jammu and Kashmir, the Government had on March 18 this year extended the free health insurance coverage of Rs 5 lakh per family to all the 1.25 crore residents of the Union Territory.
The sanction to roll out the Jammu & Kashmir Health Scheme was accorded in a meeting of the advisory council chaired by Lt Governor G C Murmu but due to sudden outbreak of COVID-19 Panemic, all Government machinery, particularly, Health and Medical Education Department were busy in containing the Pandemic which delayed the process of implementation of JKHS.
However, after a gap of over three months, Government today started process for implementation of JKHS by floating e-tender vide Notice Number SHA/AB-PMJAY/JK/20-21/1188 for the selection of insurance company to implement Universal Health Coverage in the UT of J&K.
The scheme will be soon operationalized after the completion of the tendering process. JKHS in convergence with PM-JAY provides cashless access to health care services (hospitalizations) for all the residents including employees/pensioners of the Government of Jammu and Kashmir.
As per NSSO 2014, the Out of Pocket Expenditure (OOPE) per hospitalized case in case of Rural areas is Rs 8,394 and that for Urban areas is Rs 13,615. Further, in case of Public Hospitals, the OOPE in Rural areas is Rs 6,467 and that for Urban areas is Rs 8,524. Similarly, in case of Private Hospitals, the figures are Rs 37,997 and Rs 43,384 for Rural and Urban areas, respectively.
JKHS in convergence with PM-JAY envisions to help mitigate catastrophic expenditure on medical treatment which pushes nearly 6 crore Indians into poverty each year. A Risk Cover (RC) of Rs 5,00,000 on family floater basis per eligible AB-PMJAY/JKHS Beneficiary Family Unit per annum shall be provided under the scheme.
It covers up to 3 days of pre-hospitalization and 15 days post-hospitalization expenses such as diagnostics and medicines. There will be no restrictions on the family size, age or gender. All pre-existing conditions are covered from day one. Benefits of the scheme are portable across the country i.e. a beneficiary can visit any empanelled public or private hospital in India to avail cashless treatment. In J&K, 230 hospitals are empanelled under Ayushman Bharat – PMJAY and will also be deemed empanelled under UHC in J&K.
Services include approximately 1574 procedures covering all the costs related to treatment like registration charges, bed charges (General Ward), nursing and boarding charges, surgeons, anesthetists, medical practitioner, consultants fees, anesthesia, blood transfusion, oxygen, OT charges, medicines, costs of diagnostic tests and surgical appliances etc. Hospitals will be reimbursed for the healthcare services at par with the private hospitals.
Expenses incurred for consultation, diagnostic tests and medicines before the admission of the patient in the same hospital and cost of diagnostic tests and medicines and up to 15 days of the discharge from the hospital for the same ailment/ surgery and any other expenses related to the treatment of the patient in the hospital shall be covered under this scheme.
The scheme will provide cashless hospitalization expenses coverage including treatment for medical conditions and diseases requiring secondary and tertiary level of medical and surgical care treatment including defined day care surgeries and follow -up care. The scheme will augment the public health infrastructure by improving the financial status of empanelled public hospitals of the UT. An incentive based mechanism will further boost the morale of the healthcare workers.