News Today Logo

Posted 06 May 2024

2 min read

  • Study found that patients incurred significant Medical Out-Of-Pocket Expenditure (OOPE) when admitted to private hospitals empanelled under Pradhan Mantri Jan Arogya Yojana (PMJAY).
    • This was mainly due to dual billing under which private hospitals charged patients and also claimed reimbursement under PMJAY.

 

  • About PMJAY:
    • Ministry: Ministry of Health and Family Welfare.
    • Genesis: Launched in 2018 as a component of Ayushman Bharat scheme.
    • Benefit: Provides hospital cover of Rs. 5 lakhs/ family/ year for secondary and tertiary care across public and private empanelled hospitals. 
      • There is no restriction on family size, age or gender.
    • Coverage: Covers up to 3 days of pre-hospitalization and 15 days post-hospitalization expenses.
      • It covers all pre-existing medical conditions.

 

  • Challenges with implementation of PM-JAY: 
    • Capacity deficit (High number of people per empanelled healthcare provider) in some states and delays in claim settlements despite clear guidelines.
    • Lack of essential validation controls in beneficiary registration 
      • CAG report highlighted linking of >7 Lakh beneficiaries to single mobile number.
    • Delayed grievance disposal: CAG report highlighted that only around ~10% of registered grievances were addressed within 15 days turnaround time.
    • Non-adoption of whistle blower policy by several states like Bihar, Chhattisgarh, Rajasthan etc.

 

  • Tags :
  • PMJAY
  • Ayushman Bharat
  • Out of pocket expenditure
  • Health insurance
Watch News Today
Width resize handle
Height resize handle

Search Notes

Filter Notes

No notes yet

Create your first note to get started.

No notes found

Try adjusting your search criteria.

Subscribe for Premium Features