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
Health Care Scheme | AB-PMJAY | Gov’t Medical Reimbursement | |||
Claim Count | Approved Amount (Rs) | 21234 | Approved Amount (Rs) | Claim Count | Approved Amount (Rs) |
3689 | 11,20,27,537 | 21994 | 16,75,55,362 | 17779 | 77,20,16,536 |
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
Mizoram (Intra-State) | Refer (Inter-State) | Total | |||
Count | Approved Amount (Rs) | Count | Approved Amount (Rs) | Count | Approved Amount (Rs) |
2970 | 6,07,12,119 | 718 | 5,12,47,874 | 3689 | 11,20,27,537 |
E.2. Top 20 frequently used package/Diagnosis.
Table III
Top 20 Packages/Diagnosis | |||
1 | CANCER | 11 | RENAL ALLOGRAFT RECIPIENT |
2 | NORMAL VAGINAL DELIVERY | 12 | ELECTIVE LOWER SEGMENT CAESAREAN SECTION |
3 | ALCOHOL DEPENDENT SYNDROME | 13 | LOWER RESPIRATORY TRACT INFECTION |
4 | CHRONIC KIDNEY DISEASE | 14 | CHRONIC HEPATITIS C |
5 | PNEUMONIA | 15 | NEONATAL JAUNDICE |
6 | LOWER SEGMENT CAESAREAN SECTION | 16 | CHRONIC OBSTRUCTIVE PULMONARY DISEASE |
7 | URINARY TRACT INFECTION | 17 | CHOLELITHIASIS |
8 | ACUTE GASTROENTERITIS | 18 | ACUTE FEBRILE ILLNESS |
9 | CHRONIC LIVER DISEASE | 19 | SYSTEMIC LUPUS ERYTHEMATOSUS |
10 | ACUTE APPENDICITIS | 20 | ACUTE PEPTIC DISEASE |
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
District | Hospitals/SHA | CSC’s | Total |
Aizawl | 65114 | 43540 | 108654 |
Champhai | 62060 | 9121 | 71181 |
Kolasib | 28163 | 12244 | 38056 |
Lawngtlai | 2004 | 1756 | 8830 |
Lunglei | 39515 | 2631 | 43528 |
Mamit | 6516 | 10282 | 19438 |
Siaha | 8078 | 205 | 8639 |
Serchhip | 16130 | 13947 | 30077 |
Total | 234677 | 93726 | 328403 |
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
Mizoram District | Claim Count | Claim Paid (Rs) |
Aizawl | 12493 | 121801926 |
Champhai | 1877 | 9303319 |
Kolasib | 1471 | 8946445 |
Lawngtlai | 508 | 4037750 |
Lunglei | 2543 | 8001947 |
Mamit | 650 | 3217485 |
Siaha | 315 | 1313925 |
Serchhip | 1303 | 8386614 |
Total | 21160 | 165009411 |
Table VI
Portability (Referral Outside State) | |
Claim Count | Claim Paid (Rs) |
74 | 25,45,951 |
F.3. Top Speciality and Packages Used
Table VII shows top 20 frequently used speciality/packages under Transaction Management System (TMS).
Table VII
Top 20 Packages under AB-PMJAY | |||
1 | CANCER | 11 | Enteric fever |
2 | Normal Delivery | 12 | Hemodialysis per sitting |
3 | Pneumonia | 13 | Cerebrovascular accident |
4 | Caesarian Delivery | 14 | Laparoscopic Cholecystectomy |
5 | Acutre excaberation of COPD | 15 | Scrub Typhus |
6 | UTI | 16 | Open Reduction Internal Fixation (Large Bone) |
7 | Acute febrile illness | 17 | Appendicectomy |
8 | Severe Gastritis | 18 | Pyrexia of unknown origin |
9 | Acute gastroenteritis with moderate dehydration | 19 | Respiratory failure due to any cause |
10 | Acute bronchitis | 20 | Hysterectomy ± Salpingo-oophorectomy |
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
Month | Inside Mizoram | Outside Mizoram | Total | |||
Claim count | Approved Amount (Rs) | Claim count | Approved Amount (Rs) | Claim count | Approved Amount (Rs) | |
April | 834 | 3,06,95,899 | 74 | 69,75,276 | 908 | 3,23,60,004 |
May | 1781 | 6,74,62,689 | 268 | 2,70,94,249 | 2049 | 8,42,44,254 |
June | 989 | 3,82,93,948 | 161 | 1,45,27,316 | 1150 | 4,66,20,189 |
July | 1450 | 5,25,97,299 | 220 | 2,88,29,809 | 1670 | 7,21,66,844 |
August | 1429 | 5,59,00,740 | 172 | 1,64,65,306 | 1601 | 6,29,15,090 |
September | 1587 | 5,65,00,462 | 196 | 2,27,96,536 | 1783 | 7,00,36,551 |
October | 1593 | 6,26,34,127 | 229 | 2,45,92,827 | 1822 | 7,66,21,289 |
November | 804 | 3,39,29,489 | 158 | 1,69,80,113 | 962 | 4,51,93,953 |
December | 177 | 1,16,94,048 | 51 | 73,95,226 | 228 | 1,72,06,603 |
January | 1890 | 6,99,17,209 | 243 | 2,54,57,212 | 2133 | 8,61,38,850 |
February | 1426 | 5,69,79,362 | 383 | 4,59,79,876 | 1809 | 9,60,60,175 |
March | 1412 | 5,49,93,394 | 252 | 3,29,68,059 | 1664 | 8,24,52,734 |
Total | 15372 | 59,15,98,666 | 2407 | 27,00,61,805 | 17779 | 77,20,16,536 |
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
S.N | Name of Department | Total | |
Claim Count | Approved Amount | ||
1 | HOME DEPARTMENT INCLUDING PRISONS & SAINIK WALFARE RESETLLEMENT | 4923 | 16,29,15,075 |
2 | SCHOOL EDUCATION DEPARTMENT | 3154 | 13,72,51,736 |
3 | PUBLIC WORKS DEPARTMENT (PWD) | 806 | 3,96,77,150 |
4 | POWER & ELECTRICITY DEPARTMENT | 782 | 3,84,07,515 |
5 | DIRECTORATE OF HEALTH SERVICES | 760 | 3,10,65,769 |
6 | DIRECTORATE OF HOSPITAL & MEDICAL EDUCATION | 688 | 3,44,50,457 |
7 | HIGHER & TECHNICAL EDUCATION DEPARTMENT | 657 | 3,53,01,488 |
8 | SECRETARIAT ADMINISTRATION DEPARTMENT(SAD) | 625 | 2,70,79,651 |
9 | PUBLIC HEALTH ENGINEERING DEPARTMENT (PHED) | 460 | 1,99,35,073 |
10 | FOOD CIVIL SUPPLIES & CONSUMER AFFAIRS | 364 | 1,42,84,290 |
11 | GENERAL ADMINISTRATION DEPARTMENT | 323 | 1,40,36,371 |
12 | ENVIRONMENT, FOREST & CLIMATE CHANGE DEPARTMENT | 297 | 1,50,29,900 |
13 | TRANSPORT DEPARTMENT | 269 | 1,05,92,014 |
14 | EXCISE & NARCOTICS DEPARTMENT | 260 | 1,30,82,233 |
15 | ANIMAL HUSBANDRY & VETERINARY DEPARTMENT | 249 | 1,29,06,603 |
16 | COMMERCE & INDUSTRIES DEPARTMENT | 216 | 1,26,62,825 |
17 | RURAL DEVELOPMENT DEPARTMENT | 208 | 1,25,48,719 |
18 | FINANCE DEPARTMENT | 203 | 90,52,743 |
19 | LAND REVENUE & SETTLEMENT DEPARTMENT | 181 | 62,79,416 |
20 | AGRICULTURE DEPARTMENT | 177 | 85,74,793 |
21 | SOCIAL WELFARE DEPARTMENT | 173 | 1,12,12,862 |
22 | TAXATION DEPARTMENT | 148 | 92,25,497 |
23 | HORTICULTURE DEPARTMENT | 141 | 65,65,947 |
24 | LAND RESOURCES, SOIL & WATER CONSERVATION | 119 | 59,84,159 |
25 | URBAN DEVELOPMENT & POVERTY ALLEVIATION DEPARTMENT | 119 | 55,56,672 |
26 | LOCAL ADMINISTRATION DEPARTMENT | 111 | 57,06,743 |
27 | MIZORAM LEGISLATIVE ASSEMBLY SECRETARIAT | 111 | 53,50,300 |
28 | PLANNING & PROGRAMME IMPLEMENTATION DEPARTMENT | 111 | 1,21,48,756 |
29 | LAW & JUDICIAL DEPARTMENT GOVT OF MIZORAM | 99 | 46,51,974 |
30 | SERICULTURE DEPARTMENT | 89 | 33,24,903 |
31 | IRRIGATION & WATER RESOURCES DEPARTMENT | 81 | 35,05,771 |
32 | SPORT & YOUTH SERVICES DEPARTMENT | 77 | 21,23,926 |
33 | COOPERATION DEPARTMENT | 75 | 36,06,149 |
34 | DIRECTORATE OF STATE COUNCIL OF EDUCATIONAL RESEARCH AND TRAINING (SCERT) | 69 | 34,95,099 |
35 | PRINTING & STATIONARY DEPARTMENT | 67 | 29,25,845 |
36 | ART & CULTURE DEPARTMENT | 62 | 39,86,629 |
37 | INFORMATION & PUBLIC RELATIONS (I&PR) DEPARTMENT | 62 | 37,33,512 |
38 | MIZORAM PUBLIC SERVICE COMMISION | 51 | 29,53,681 |
39 | VIGILANCE DEPARTMENT | 49 | 44,46,787 |
40 | GOVERNOR'S SECRETARIAT | 46 | 30,86,717 |
41 | TOURISM DEPARTMENT | 43 | 22,67,149 |
42 | FISHERIES DEPARTMENT | 41 | 19,78,712 |
43 | LABOUR, EMPLOYMENT, SKILL DEVELOPMENT & ENTREPRENUERSHIP | 41 | 11,50,850 |
44 | DIRECTORATE OF DISASTER MANAGEMENT AND REHABILITATION | 40 | 20,70,869 |
45 | MIZORAM BOARD OF SCHOOL EDUCATION | 30 | 9,42,301 |
46 | DIRECTORATE OF SCIENCE AND TECHNOLOGY | 28 | 8,52,998 |
47 | STATE ELECTION COMMISION | 22 | 10,31,113 |
48 | SIPMIU DEPARTMENT | 21 | 9,38,951 |
49 | DEPARTMENT OF PERSONNEL & ADMINISTRATION REFORMS | 16 | 8,48,474 |
50 | INFORMATION & COMMUNICATION TECHNOLOGY DEPARTMENT | 16 | 5,95,486 |
51 | MIZORAM INFORMATION COMMISSION | 8 | 1,32,175 |
52 | MIZORAM SCHOLARSHIP BOARD | 8 | 4,09,586 |
53 | PARLIAMENTARY AFFAIRS DEPARTMENT | 3 | 72,122 |
GRAND TOTAL | 17779 | 77,20,16,536 | |
