25000 Ayushman Bharat Hospitals to soon treat CGHS beneficiaries

New Delhi: The government is considering allowing the beneficiaries of the Central Government Health Scheme (CGHS) to seek treatment at the hospitals empanelled with the flagship Ayushman Bharat-Pradhan Mantri Jan Arogya Yojna (AB-PMJAY) to provide more hospital options for the patients. 

A senior government official said, "It is being planned that the beneficiaries of the CGHS scheme can also seek treatment at any of the hospitals across the country empanelled under the Ayushman Bharat-Pradhan Mantri Jan Arogya Yojna. It will ensure patients have a larger ambit of hospitals to choose from, especially those patients who are looking for super specialty treatment." He added, "By offering the option of getting treated at AB-PMJAY hospitals, the ambit would increase for beneficiaries." 

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The CGHS and AB-PMJAY are two separate health insurance schemes run by the government. The CGHS scheme is for serving and retired Central government employees. There are around 4.1 million beneficiaries registered under the scheme, and 2000 hospitals and diagnostic centres are empanelled across the country. Under the AB-PMJAY, there are around 107.4 million beneficiaries, and nearly 37.5 million hospital admissions, amounting to approximately ₹45,000 crores, were authorised under the scheme through a network of 25,000 empaneled health care providers. 

At a select briefing last month, the Union health minister Mansukh Mandaviya stated that they are planning to make some changes in the current public health insurance schemes, including creating a unified card for AB-PMJAY and schemes run by individual states. Mandaviya stated, "It will be a unified card that will be called Ayushman Card. What we have essentially done is co-branding, whereby beneficiaries can use treatment packages under Central and state-run health insurance schemes using just one card. Many states have their health insurance schemes, and there was a lot of confusion among beneficiaries regarding empanelled hospitals, implementation support agencies, insurance companies, and third-party administrators. Now there will be a common name." Around 20 schemes are currently being run by several states, according to the union health ministry. 

The government is in the process of creating new cards that would have both the Central and state government logos, with an imprint of 'Ayushman Bharat Pradhan Mantri Jan Arogya Yojna-Mukhya Mantri Yojna' to suggest unification. Under this, the eligible beneficiaries of any government insurance scheme could seek treatment facilities at any of the 25,000 empanelled hospitals under the central scheme, reports the Hindustan Times. 

According to an official, it is not legally compulsory for states to implement the changes, however, all states except Delhi, Odisha, and West Bengal have agreed to implement the proposed changes. An official said, "The benefit of patients is at the core of all changes that are being envisaged to improve the public health insurance segment."

Dr. MC Misra, former director, All India Institute of Medical Sciences, Delhi, said, "The idea of expanding Ayuhsman Bharat empanelled hospitals to CGHS beneficiaries is good as these will be private hospitals offering multi-specialty care. The options will obviously widen, which is a good thing," adding, "However, it will be better if the cashless benefit that Ayushman Bharat beneficiaries get is also be extended to CGHS beneficiaries." 

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