Study by researchers from State health resource centre in Chhattisgarh analysed PM-JAY implementation

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.

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