Under the Ayushman Bharat scheme, around 86 per cent of the 46,000 claims have been raised by private hospitals and
Over 46,000 claims have been raised under the Ayushman Bharat scheme in Jharkhand with close to 86 per cent of the claims having been raised by private hospitals, reports The Hindu Business Line. 60 per cent of the 580 empanelled hospitals in Jharkhand are private ones, the report further states.
On the other hand, in the neighbouring state of Bihar, only around 5,700 claims have been raised under the scheme.
Ayushman Bharat scheme, launched by the PM Modi on 23 September 2018, aims to provide healthcare insurance cover of upto Rs. Five lakh per family to 10.74 crore families. The scheme would benefit approximately 55 crore people, making it the world’s largest government healthcare programme.
The difference in success rates between the two states has been attributed to different models adopted by them in implementing the scheme. While Bihar has adopted the trust model, Jharkhand has used the hybrid one.
In the former, a state creates a trust to manage the scheme and claims are disbursed from a corpus created from central and State government funds. However, in the latter hybrid model, while the insurance company pays a part of the claim, the balance is paid by the state-run trust.
Why The Hybrid Model Works?
“In a hybrid model, frauds are minimised because the insurance player is incentivised to keep the claims low. If the claims’ rejection is legitimate, then we support it. But if the claims are rejected on flimsy reasons, we try to control it," said Divyanshu Jha, the Executive Director of Jharkhand State Arogya Society to BL.
"In the longer run, the revenue outflow will depend on the fraud detection built into the system. If the insurance player raises issues on fraud then we will look into it and de-empanel hospitals wherever need be. This balance is not there in a trust model,” he added.
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