Highest ever pre-authorsations under Ayushman Bharat-Arogya Karnataka recorded in May

SAST has settled claims worth ₹ 225 crore, including ₹ 125 crore to private hospitals

SAST has settled claims worth ₹ 225 crore, including ₹ 125 crore to private hospitals

Karnataka has recorded the highest ever pre-authorizations under the Ayushman Bharat-Arogya Karnataka, its flagship health insurance scheme, in May this year that saw 1.55 lakh.

While over 13 lakh pre-authorizations were recorded in the whole of last year, nearly 3 lakh have been recorded in the first two months of this financial year itself.

According to data from the Suvarna Arogya Suraksha Trust (SAST), the nodal agency that is implementing the health scheme, this year so far the demand is high for simple secondary general procedures followed by general medicine and gynecology.

Claims worth a total of ₹ 225 crore raised by empanelled hospitals, including ₹ 125 crore by private facilities, have been settled by SAST this financial year so far. With this, 2,61,585 patients have been treated free of cost under AB-ArK this financial year.

As many as 2,75,804 simple secondary general procedures have been performed under AB-ArK this year. This is followed by 97,084 general medicine procedures and 93,058 obstetrics and gynecology procedures performed in empanelled hospitals.

While emergency medicine and interventional neuroradiology procedures have been the least this year, at 10 and 78 respectively.

The scheme

Arogya Karnataka that was rolled out in March, 2018, was co-branded with Ayushman Bharat on October 30 the same year, after the State signed a Memorandum of Understanding (MoU) with the Center.

Following the co-branding of the two schemes, the annual health cover (under Arogya Karnataka) of ₹ 1.5 lakh a year for a BPL family of five, with additional assistance of ₹ 50,000 in some cases, has been enhanced to 5 lakh a. year per family in the State.

The integrated scheme covers simple secondary, complex secondary, tertiary and emergency procedures. Primary treatments and simple secondary procedures are limited to public health institutions (PHIs).

Complex secondary procedures, tertiary procedures, and emergency procedures are performed in PHIs and empanelled private hospitals.

Highest pre-authorsations

Of the total 1,55,098 preauthorisations recorded this financial year, 91.3% are from public health institutions. Bengaluru Urban, Hassan, and Mandya have recorded the highest with 12,404, 10,826, and 10,198, respectively.

Yadgir, Kodagu, and Chickballapur have recorded the lowest with 2,241, 2,245, and 2,309 pre-authorisations respectively.

State Health Commissioner Randeep D., who is also the in-charge Executive Director of SAST, said pre-authorizations have consistently improved this year. “Public health institutions have been the largest contributors. According to our analysis, the performance of private facilities is more only during the peak of the pandemic, except the third wave. Last year, 13 lakh pre-authorizations were recorded and this financial year, in the first two months itself, we have touched 3 lakh cases. We are poised to exceed 15 lakh this financial year, ”he said.

Pointing out that videoconferences with District Health Officers (DHOs) and District Surgeons are regularly being held since March this year, the Commissioner said, “The district officials are encouraged to ensure more patients are treated under the AB-ArK scheme. We review the performance every Tuesday and low performing public facilities are pulled up ”.

“Public facilities benefit as claim amount flows back to them. Claim funds will be used for upgradation of the public health institutions and strengthening of service delivery, ”he added.

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