Ayushman may have 2 categories with different funding, coverage in Bengal

Kolkata: There could be different funding and coverage for Ayushman Bharat beneficiaries in Bengal — one for those who qualify under the existing criteria and the other for the rest, a large number of whom belong to the middle- and lower-income groups and are now covered under Swasthya Sathi, said a source close to the health department. Under Ayushman norms, all aged 70 years and above, apart from those below the poverty line, qualify, while others need to fulfil a set of stringent criteria that may leave out a sizeable section of the state's population. Swasthya Sathi was a universal scheme. "The integration process may see two categories to include those who now hold Swasthya Sathi cards but will be left out of Ayushman Bharat. So, there could be a separate set of packages and funding patterns for them. The other will be a general category for those who qualify under existing criteria," said the source. An official confirmation was unavailable. Ayushman Bharat is funded by the Centre and the state in a 60:40 ratio. "Initially, Ayushman will cover the 70-plus population and those who satisfy existing norms. In the next phase, it will be extended to the middle- and lower-income groups who were covered under Swasthya Sathi but don't fulfil Ayushman norms. The funding ratio could be different and the modalities are yet to be finalised. The coverage patterns and rates could be different for the two categories," the source added.Private hospitals were divided on whether the new scheme should cover all or not. While some felt Ayushman should be restricted to the poor, who could not afford private hospital treatment, others felt it needed to be extended beyond them. "The two-card theory is an ideal arrangement as a state scheme needs to cover most of the population. Also, the packages need to be priced reasonably for hospitals to find it easy to accept Ayushman patients," said Rupak Barua, president, Association of Hospitals of Eastern India and Woodlands CEO.Charnock Hospital, which is in the process of boarding the Ayushman platform and has got its health facility registry mapped with its central govt health scheme platform, supports the move. "This will help extend the scheme to a larger section of the population. If coverage is extended through a seamless integration, we should have a sizeable section of Swasthya Sathi beneficiaries covered," said Charnock MD Prashant Sharma. "Ayushman is expected to play an important role in enhancing healthcare accessibility and affordability," said Ayanabh Debgupta, regional director (east), Manipal Hospitals.Some felt those with personal or corporate health insurance or are financially well-placed, might ideally stay outside the scheme. "It will help us look after those who truly need aid," said Rupali Basu, regional business head, East & AP, HCG Cancer Hospitals.