Maharashtra's Health Scheme Set to Provide Rs 5 Lakh Coverage Per Family

The Mahatma Jyotirao Phule Jan Arogya Yojana is a health scheme that was launched in Maharashtra. The scheme is aimed at providing quality health care to citizens of the state, especially those from lower-income groups. The scheme was launched in 2012 and has since been providing financial protection to millions of families in the state.

The scheme has been a success and has received praise from various quarters for its effectiveness. However, it has also faced criticism for its limited coverage and the limited number of empaneled hospitals. The governing body of the scheme has now proposed five critical changes to address these issues and improve the scheme's effectiveness.

The first proposed change is to increase the cover for every family from Rs 1.5 lakh to Rs 5 lakh. This increase in coverage will provide much-needed financial protection to families, especially in times of medical emergencies.

The second proposed change is to expand the number of medical procedures covered under the scheme. Currently, the scheme covers 996 medical procedures, but the State Health Assurance Society, which governs the scheme, has proposed to increase the number to 1,209. This will provide better access to healthcare for citizens and ensure that more medical procedures are covered.

The third proposed change is to add more empanelled hospitals to the scheme. Currently, the scheme has around 1,000 empanelled hospitals, but the governing body has proposed to add around 500 more hospitals, bringing the total to 1,500. This will ensure that citizens have better access to healthcare facilities across the state.

The fourth proposed change is to revise the surgery and procedure rates, which have remained unchanged since 2018. The rates of procedures and surgeries will be a significant point of discussion, and comparative studies will be done. Sources told the press that an increase of 20% might be under consideration. In Mumbai, most significant hospitals and even mid-range facilities have not participated in the scheme over cost.

The fifth proposed change is to explore the possibility of turning the scheme into a scheme universally applicable to all state citizens, irrespective of income. This move will provide better social security for more citizens and align the scheme with the Ayushman Bharat-Pradhan Mantri Jan Arogya Yojana, a parallel central-state scheme that covers a different set of beneficiaries. The proposal is being evaluated by a special committee under the commissioner, National Health Mission, and the changes aim to implement the changes in 2-3 months. The cost implications to the state are also being evaluated, and Maharashtra currently pays an annual premium of Rs 1,700 crore to cover 2.2 crore families.

Civil society members have welcomed the expansion but have called for more empanelled hospitals, particularly in northern Maharashtra, where people are required to travel hundreds of kilometers if they wish to avail of the scheme. They have also called for the government to organize consultations with public health experts and civil society organizations to obtain their inputs towards upgrading the scheme.