Achievement-Healthcare

 Achievement during 2021-22

Ayushman Bharat - Pradhan Mantri Jan Arogya Yojana (ABPM-JAY):

There are 1.9 lakhs eligible families in the state and as each member needs to have their ownidentity card, the challenge of verification process and issue of card arises. For this, as it would be a big burden for hospitals alone to issue e-card, State Health Agency, Mizoram liaised with Department of Information & Communication Technology (ICT) by integrating with Common Service Centres (CSC’s) available at almost every locality along the State. Further, State Health Agency, Mizoram also setup teams to visit hardship places with no or poor internet connectivity to make sure each eligible beneficiary has their own identity golden card prior to exposure from diseases. The endeavour of the sincerity and hard work of all the workers generated 368456 golden cardsso far. The detail of claims during policy year 2021-2022 is highlighted in below table.

Government Employee & Dependants Medical Re-imbursements:

            The Government of Mizoram had assigned MSHCS to screen and scrutinise all medical reimbursement claims of Government servants and their dependents since 2018-19, though payment is not done by the Society, it screens and recommends the approved amount based on Government Notified rates, whereupon, the concerned Treasury makes the payment to the Government Servant. The details of claim scrutinised during the year 2021 to 2022 is highlighted in below table.

Achievement - Healthcare during 2019-20

 Claims Paid and Screened.

            The total number of claims approved and paid for HealthCare Scheme and AB-PMJAY as well as the total number of Medical Reimbursement approved is highlighted in Table I below.

Table I 

E.  Mizoram State Health Care Scheme (MSHCS)

            The Mizoram State Healthcare Scheme was revised and upgraded to give social security to each bonafied residents enrolled under the scheme by providing health benefits to cover al hospitalized ailments and selected 26 OPD cases from October 2019 and covering a sum insured amount of Rs. 2 lakhs only. Prior to it, only pre-selected critical illness up to a sum insured amount of Rs 3 lakhs were covered under the Scheme. The data generated would not give a full picture of the disease burden of the state, thus a bias in the overall utilization for claims payment as well as in the disease burden. However, an attempt has been made to highlight the disease burden with the available existing data.

E.1.  Intra State & Inter State Treatment.

             Regardless of the treatment inside the State, most tertiary cases are referred outside the state and Table II shows the variation of treatment within Mizoram and outside Mizoram.

             Table II

E.2. Top 20 frequently used package/Diagnosis.

Table III

F. Ayushman Bharat - Pradhan Mantri Jan Arogya Yojana (AB-PMJAY)

Ayushman Bharat PM-JAY had replaced RSBY since October, 2018 and provides a health benefit cover of Rs. 5 lakhs per family per year for in-hospitalization for its eligible vulnerable families. It is a cashless access to health care services for the beneficiary at all empanelled hospitals and helps mitigate catastrophic expenditure on medical treatment. At present, there are 85 empanelled hospitals in the State of which 80 hospitals come under public sector and 5 hospitals under private sector. 

F.1. Beneficiary Identification System (BIS)

            Unlike other health insurance scheme, it is mandatory that all eligible member of the household must have e-card, also called as Golden Card to avail the benefits under the scheme.

There are 1.9 lakhs eligible families in the state and as each member needs to have their own identity card, the challenge of verification process and issue of card arises. For this, as it would be a big burden for hospitals alone to issue e-card, State Health Agency (SHA), Mizoram liaised with Department of Information & Communication Technology (ICT) by integrating with Common Service Centres (CSC’s) available at almost every locality in the State. Further, State Health Agency, Mizoram also setup teams to visit hard to reach places and other villages having lower e card issuance and having no or poor internet. The endeavour and hard work of all the workers generated 328403 golden cards within a year. Table IV shows the variation of e-card generated by districts of Mizoram.

Table IV

F.2. Intra State & Inter State Treatment.

                           The variation of treatment/in-hospitalisation within districts of Mizoram and portability (referral outside Mizoram) are mentioned in the Table V and VI.

Table V

Table VI

F.3. Top Speciality and Packages Used

            Table VII shows top 20 frequently used speciality/packages under Transaction Management System (TMS).            

Table VII         

G. Government Employee & Dependants Medical Re-imbursements

            Screening of Government Servants Medical Reimbursement (MR) claims was executed by the Society from April 2018 using Government approved rates. Streamlining

G.1. Intra State & Inter State Treatment.

        As shown in the Table VIII highlights the month wise total number of medical claims approved for intra and interstate and the amount approved in Rupees is as given:

Table VIII

G.2. Top 20 Department wise no of Medical Reimbursement claims

  Table IX shows Department wise no and amount of Medical Reimbursement claims.

  Table IX