At around 2:00 AM, in the dead of the night, Naseer Ahmad complained of severe chest pain. He found it difficult to breathe. With every passing movement, pain became unbearable.
Ahmad was rushed to District hospital, Bandipora, where doctors gave him necessary treatment and advised him to visit Shri Maharaja Hari Singh (SMHS) Hospital, in Srinagar, some 60 kilometers away from his residence for further treatment.
When Ahmad reached SMHS hospital, his condition worsened. After examination, a team of doctors diagnosed him with lung cancer.
“We were shocked and numb,” said Parveez Ahmad, brother of Naseer.
The family took Ahmad to a private hospital, where he was informed that he would need immediate treatment which would cost him around 5 lakh rupees.
This was the real ordeal for the family, who realised that it was impossible for them to afford such a huge amount for Ahmad’s treatment, who wasn’t earning.
“We felt helpless. When we asked for help from hospital authorities, they told us that they could help us in case we had the golden card of Ayushman Bharat,” Parveez told Kashmir Observer.
The Ayushman Bharat PM-JAY SEHAT scheme was launched by the Prime Minister of India on 26th December 2020 in Jammu and Kashmir in order to provide benefits to all residents of UT of Jammu and Kashmir (more than 20 Lakh families).
This information reinvigorated their hope in Ahmad’s treatment. When they submitted their golden card to the hospital administration, the treatment started being funded under the Ayushman Bharat Scheme immediately.
“We are under Below Poverty Line (BPL) category and too poor to afford his treatment but thanks to this SEHAT scheme, who took away all our worries,” Parveez added.
This is for the first time that a publicly funded Health Insurance Scheme meant for the entire population is being implemented in the UT.
Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) scheme has emerged as a ray of hope for numerous other poor families who cannot afford health treatment at prestigious and premier medical institutes of the country.
Data provided by the State Health Agency, a copy of which lies with Kashmir Observer revealed that till date around 82.59 lakh beneficiaries have been registered in the UT of Jammu and Kashmir with over 9,07,368 number of admissions.
The scheme is implemented through insurance mode and Private Bajaj Allianz GIC is the implementing agency for Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (PMJAY) and AB PM-JAY SEHAT in Jammu & Kashmir.
The AB PM-JAY benefits all the residents of Union Territory including employees and pensioners as well. To carry out the Pre and post hospitalization charges, Empanelled Hospitals are fully instructed for providing pre and post hospitalizations services under the scheme.
Like Ahmad, thousands of patients have utilised the advantages of the golden cards to receive treatment at private and government hospitals without paying fat medical bills.
Misra Begum, a resident of Karan Nagar, Srinagar was suffering from knee pain for the last five years. She explored all the options and visited every orthopedician but she was finally advised for a total knee replacement at a private hospital in New Delhi.
Her husband, Bilal Ahmad, who runs a grocery shop in karan nagar couldn’t afford the treatment of his wife.
“I came to know about the SEHAT scheme from a friend. I quickly got the golden card of my wife and rushed her to New Delhi, where doctors performed her surgery at a private hospital under the PMJAY SEHAT card free of cost,” Ahmad added.
Ahmad while expressing gratitude to the Center and UT government for launching this poor friendly scheme said “SEHAT card helped us a lot, as our financial condition was not good and my treatment was almost impossible without this scheme,”
Sanjiv M. Gadkar, Chief Executive Officer, State Health Agency told Kashmir Observer that a number of packages under this scheme are provided free of cost for BPL families.
“Around 200 packages are available, which are free of cost. People should approach those hospitals only which are empaneled under the scheme and reap the benefits of this scheme,” Gadkar said.
He further revealed that all the surgeries don’t come under this scheme and that it covers up to five lakh only. However, “In some cases if the expenditure goes up to 10 lakh, the hospital takes permission from us and we provide the same,” he added.
An official from the health department told Kashmir Observer that SEHAT scheme is proving to be a game-changer as over 9 lakh patients have received free treatment on which Rs 1500 crore have been spent so far.
The official added that over 82 lakh Ayushman cards have been issued and around 230 hospitals have been empanelled by the government. He further stated that over 08 lakh claims have been submitted and 88% have been settled so far.
The scheme provides a cover of Rs. 5 lakh per family per year. All Medical and surgical conditions are included with minimal exclusions. It covers both Pre and Post hospitalization expenses. More than 90% of the major Private hospitals in J&K have been empaneled under the scheme.
PM-JAY provides cashless cover of up to Rs 5,00,000 to each eligible family per annum for listed secondary and tertiary care conditions. Services include approximately 1,393 procedures covering all the costs related to treatment, including but not limited to drugs, supplies, diagnostic services, physician’s fees, room charges, surgeon charges, OT and ICU charges etc.
An official of the state health agency told Kashmir Observer that ever since the launch of the scheme, the footfall of patients from hard-to-reach areas in tertiary care facilities has considerably increased.
“This quantum jump indicates improved health seeking behaviour which can be attributed to a lot of factors viz financial protection offered by the scheme, comprehensive advocacy/ awareness plan vis a vis coverage under the scheme,” the official said.
He further said that under the ambit of Ayushman Bharat Pradhan Mantri Jan Arogya Yojana, the State Health Agency has achieved many milestones in the last 4 years of its existence. Over 100% of families in J&K have at least one Ayushman card. More than 8.19 lakh free and cashless treatments have been provided to J&K domiciles including treatments received outside J&K using portability option and the treatments amount to more than Rs. 1400 Crores. On an average, the daily claim outgo is about Rs. 2 Crores.
The scheme has become a ray of hope for the poor and needy. To make the scheme’s future sustainable, the Government is ramping up its efforts to focus on several aspects of the policy.
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