A day after the newly constituted Delhi Cabinet okayed the implementation of the Ayushman Bharat insurance scheme in the national capital, the process of training has commenced for the staff who will generate the golden cards and those who will work to pre-authorise medical procedures.
As many as 6.54 lakh of the poorest families in Delhi will receive health coverage up to Rs 5 lakh. An estimated 4.5 lakh families with people over the age of 70 — some of whom may already be eligible for cover as per their economic status — will also benefit from the scheme.
The rollout of the scheme was approved by the Delhi Cabinet at its first meeting on Thursday. Chief Minister Rekha Gupta said that the Delhi government will provide an additional cover of Rs 5 lakh to those eligible.
Delhi is the only state along with West Bengal where the Ayushman Bharat scheme has not been rolled out yet. The Aam Aadmi Party government in Delhi had earlier refused to implement the scheme in the capital claiming that the Delhi government's schemes were better than the one rolled out by the central government.
The AAP’s schemes included free treatment for all citizens in government hospitals and free surgeries in 81 private hospitals for those who had to wait a long time for diagnoses and treatment in government-run hospitals.
A Health ministry official said that the process of creating the database has begun and will cover the poorest Delhi residents, those above the age of 70 years, and ASHA and Anganwadi workers, once implemented.
"In addition, the state may also provide cover for transgender individuals, construction workers, sanitation workers, and any other category of individuals," the official said.
Every state has a quota of the number of beneficiaries under the scheme for which the Centre provides a share of the premium — the state may choose to cover additional beneficiaries through the same system by paying the entire premium.
According to The Indian Express, the first step towards rolling out the scheme in Delhi will involve the signing of an MoU between the Centre and the state once the back-end preparations are in place. Delhi is likely to go in for a trust model initially to ensure quick rollout of the scheme.
"The scheme will start off with a trust model. It takes longer to set up Ayushman Bharat through the insurance model because tenders have to be floated to secure a contract with an insurance provider," the official said. Under the trust model, the state health authority is registered as a trust and is responsible for purchasing the services directly from empanelled hospitals.
The other way to implement the scheme, which Delhi may opt for later, is the insurance model in which the state contracts an insurance company to cover the beneficiaries. Under the insurance model, the insurance company is responsible for pre-authorising treatments, processing claims, and fraud detection.
As per the IE report, the process of training the 'master trainers' to generate new Ayushman Bharat cards has already begun. This will be followed by these master-trainers training around 6,000 others in the process.
Back-end staff are also being trained to deal with the claims process once people start filing them after the rollout of the scheme. These back-end personnel will also be responsible for taking care of the pre-authorisation process before the treatment begins, officials said.
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