In its first year, the Pradhan Mantri Jan Arogya Yojana (PMJAY), the tertiary care arm of Ayushman Bharat, has funded the treatment of 90,000 cancer patients through 1.8 lakh hospital admissions. This is according to data available with the Union Health Ministry, which also show that every year there are 11.57 lakh new cancer patients in India and 7.84 lakh cancer deaths. At any given point, there are 22.5 lakh Indians living with cancer.
- Tamil Nadu, with 40,056 cases, tops the state where the most cancer patients availed treatment under PMJAY, followed by Kerala (22,000), Madhya Pradesh (19,455), Chhattisgarh (15,997) and Gujarat (14,380).
- Officials say the figures reflect not just cancer incidence in these states but also the availability of treatment facilities and how well PMJAY is performing in these states. The cancer care claims under PMJAY show a steep rise over the past year.
- In September 2018 — the scheme was launched on the 23rd of that month — there were just 906 hospitalisation claims across the country for cancer. In September 2019, the figure was 87,382.
- The National Health Authority (NHA) has so far sanctioned Rs 321 crore for cancer care. Of the total cancer packages claimed, 30,376 are for cancer of the reproductive system such as the cervix, ovary, testes etc. 28,506 breast cancer packages have been claimed while PMJAY has funded treatment of 21,379 GI cancer cases and 14,639 of blood and blood vessels. NHA officials say these figures are in line with cancer incidence in the country.
- The NHA is responsible for the implementation of PMJAY under which 10.74 crore families will be entitled to an annual health cover of Rs 5 lakh per family. Until now, of the intended 50 crore beneficiaries, over 10 crore e-cards have been issued.
- That India has large unmet cancer treatment facilities is fairly well known and with many reaching hospitals at an advanced stage, which makes treatment unaffordable, only adds to the cancer mortality figures.
- To address this, under Ayushman Bharat, at the health and wellness centres (HWC), screening has started for three types of cancer – oral, cervical and breast. Health Ministry officials say that until August 2019, of the 76 lakh screened for oral cavity cancer, 10,218 people are being treated.
- More than 53 lakh women were screened for breast cancer and around 9,700 women are on treatment. More than 37 lakh women have been screened for cervical cancer and around 10,000 are on treatment.
- As HWCs become operational, a significantly large number of cancer cases will be detected. In addition, with PMJAY getting mainstreamed, demand for treatment including cancer will expand.
- More than 1,000 hospitals are empanelled with the NHA for cancer care. Radiation oncology packages are the third-most claimed under tertiary care packages and medical oncology is the sixth-most claimed, show NHA data. The other top tertiary care packages are for cardiovascular diseases, orthopaedics and urology.
- Incidentally, the data also show that against overall scheme portability of just 1% (patients from one state availing treatment in another), for cancer the figure is in the 7% range. This means many more people are travelling away from their home states for cancer than for other diseases.
- Ayushman Bharat - Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) is a Centrally Sponsored Scheme having central sector component under Ayushman Bharat Mission anchored in the Ministry of Health and Family Welfare (MoHFW).
- It is an umbrella of two major health initiatives, namely Health and wellness Centres and National Health Protection Scheme.
Health and Wellness Centres
- Under this 1.5 lakh existing sub centres will bring health care system closer to the homes of people in the form of Health and wellness centres.
- These centres will provide comprehensive health care, including for non-communicable diseases and maternal and child health services.
List of Services to be provided at Health & Wellness Centre
National Health Protection Mission (AB-PMJAY)
- Pregnancy care and maternal health services
- Neonatal and infant health services
- Child health
- Chronic communicable diseases
- Non-communicable diseases
- Management of mental illness
- Dental care
- Eye care
- Geriatric care Emergency medicine
- AB-PMJAY provides a defined benefit cover of Rs. 5 lakh per family per year. This cover will take care of almost all secondary care and most of tertiary care procedures.
- To ensure that nobody is left out (especially women, children and elderly) there will be no cap on family size and age in the scheme.
- The benefit cover will also include pre and post-hospitalisation expenses. All pre-existing conditions will be covered from day one of the policy. A defined transport allowance per hospitalization will also be paid to the beneficiary.
- Benefits of the scheme are portable across the country and a beneficiary covered under the scheme will be allowed to take cashless benefits from any public/private empanelled hospitals across the country.
- The beneficiaries can avail benefits in both public and empanelled private facilities. All public hospitals in the States implementing AB-PMJAY, will be deemed empanelled for the Scheme.
- Hospitals belonging to Employee State Insurance Corporation (ESIC) may also be empanelled based on the bed occupancy ratio parameter. As for private hospitals, they will be empanelled online based on defined criteria.
- To control costs, the payments for treatment will be done on package rate (to be defined by the Government in advance) basis. The package rates will include all the costs associated with treatment.
- For beneficiaries, it will be a cashless, paper less transaction. Keeping in view the State specific requirements, States/ UTs will have the flexibility to modify these rates within a limited bandwidth.