16% who went to private hospitals under Ayushman Bharat-Arogya Karnataka claimed 58% funds

Data shared by Kumar showed that the overwhelming majority of beneficiaries used public health facilities

As many as 36.7 lakh people have benefited from the Ayushman Bharat-Arogya Karnataka (AB-ArK) public insurance scheme since its launch in November 2018.

The scheme covers treatment in government hospitals and in empanelled private hospitals.

Though only a small proportion of beneficiaries used private hospitals under the scheme so far, these hospitals claimed the majority of the funds, according to T K Anil Kumar, principal secretary (health).

Kumar was speaking at Arogya Manthan 2022, a two-day event organised by the National Health Authority, Delhi.

Data shared by Kumar showed that the overwhelming majority of beneficiaries (84 per cent) used public health facilities.

This is not surprising, given that the scheme requires all simple secondary procedures to be done in government facilities.

Even in the case of tertiary and complex secondary procedures, the patient is supposed to go to a government facility first.

They can get a referral to a private hospital only if the government facility doesn’t provide the procedure.

In case of emergency care, the patient can use either public or private hospitals.

Though only 16 per cent (5.7 lakh) beneficiaries got treated in private hospitals overall in the last four years, they claimed a total of 58 per cent of the funds spent under the scheme so far.

That is, of the Rs 4,994 crore approved under the scheme so far, Rs 2,920 crore have been spent on private hospitals. The remaining Rs 2,073 crore has been spent at government hospitals.

“This is primarily because the cost of tertiary care is much higher. The outflow to the private sector is on the higher side when tertiary care is unavailable in the public sector,” Kumar said.

Under the scheme, households below poverty line can claim up to Rs 5 lakh annually for treatment, whereas those in APL category can claim 30 per cent of the treatment cost, up to Rs 1.5 lakh.

However, Kumar said that the number of procedures in government hospitals has been increasing steadily. For example, in August 2019, only around 39,200 procedures were done in government hospitals. Three years later, in August 2022, 1.9 lakh procedures were done.

Kumar said that the specialty services in government hospitals would be strengthened, along with the quality of care, so that more beneficiaries can use public facilities.