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