Ayushman Bharat-Arogya Karnataka does not fully deliver on promised assurance of health coverage  

Four years after it was implemented, the scheme continues to face problems. Afshan Yasmeen reports on There are issues like reluctance of private hospitals to empanel, non-revision of rates, and many ailments not being covered

Four years after the Ayushman Bharat Arogya Karnataka (AB-ArK), the State’s flagship health assurance scheme, was launched, easy access and free treatment during emergencies still eludes people.

With most emergencies usually falling in the cardiac and trauma-related speciality, getting treatment within the golden hour is crucial for patients. Although patients are free to walk into any empanelled hospital (public or private) without the mandatory referral (required under the scheme) during emergencies, patients tend to rush to the nearest available private hospital and end up paying out of their pockets many times. With not more than 51 private hospitals in Bengaluru empanelled under the scheme, it is hard for patients to find the right one during emergencies.

The scheme covering 5.09 crore beneficiaries was launched to provide cashless primary, secondary and tertiary health care to the poor and vulnerable population. It is being implemented in an “Assurance Mode” by Suvarna Arogya Suraksha Trust (SAST), the State’s nodal health agency.

In Bengaluru, with only 51 empanelled hospitals, that too not evenly spread out in the city, families of patients have to either pay and get treatment or commute through the city’s horrendous traffic looking for an empanelled hospital. Sometimes, they end up paying even at an empanelled hospital as some facilities have empanelled themselves for selective specialities due to low package rates and late payment issues.

Besides, although the total coverage is up to ₹5 lakh per family under the scheme, many complex life-saving procedures or implants that cost above ₹2 lakh are not covered. This makes it inevitable even for BPL patients to pay out of their pockets for such procedures.

Doctors said many patients are not aware that the ₹5 lakh coverage is for a family of five. Even if the family has a single patient, individual coverage can be only upto ₹1.75 lakh.

Moreover, there are some diseases that require staged procedures. A second procedure may be required within six months of the first procedure. But the cost of the second procedure is not covered under the scheme.