The Centre’s flagship healthcare scheme Ayushman Bharat – Pradhan Mantri Jan Arogya Yojana (PMJAY) —is not ticking the right boxes in Meerut, a tier-2 city adjoining the national Capital, as a team of researchers has found.
It noted that at least 64.5 per cent of hospitals surveyed were not satisfied with the health benefit packages under the scheme while 77.4 per cent of hospitals perceived the scheme to be poorer as compared to private health insurance.
The health providers attributed the dismal response to poor grievance redressal, poor claim processing and settlement, denial of reimbursement of health packages, poor rates of health packages and little information about the scheme that was launched in 2018.
The study, published in the Indian Journal of Community Medicine was conducted in hospitals of Meerut in Uttar Pradesh.
The authors noted that surveyed hospital authorities reported various hurdles in the implementation of the scheme.
“There definitely remains a huge scope for further improvements so as to enhance the insurance coverage in the country,†they said after surveying eight public and 23 private hospitals through simple random sampling from the list of PMJAY empanelled hospitals.
The PMJAY Medical Officer coordinators in the empanelled hospitals were interviewed using a predesigned and pretested questionnaire.
“Among the 31 empanelled hospitals studied, 93.5 per cent were satisfied with the process for empanelment under PMJAY.
‘However, 64.5 per cent of hospitals were not satisfied with the health benefit packages,†said the report titled ‘Implementation challenges of Pradhan Mantri Jan Arogya Yojana: A Cross-Sectional study in Meerut, Uttar Pradesh’.
Similarly, at least 77.4 per cent hospitals perceived the PMJAY to be poorer as compared to private health insurance with reasons being poor grievance redressal, poor claim processing and settlement, denial of reimbursement of health packages, poor rates of health packages and little information about the scheme.
The gaps pointed out in the study may provide food for thought for the authorities to plug the gaps in tier-2 cities.
The team consisted of researchers namely Niharika Verma, Tanveer Bano, Harivansh Chopra, Ganesh Singh and Chhaya Mittal, all from Lala Lajpat Rai Memorial Medical College in Meerut in Uttar Pradesh.
The PMJAY provides health cover of Rs. 5 lakh per family per year for secondary and tertiary care hospitalization to the bottom 40 per cent of the Indian population.
Health insurance plays an important role in the betterment of health providing effective and efficient health care for citizens, most especially for the poor and vulnerable. Only 37.2% of India’s total population is covered under any health insurance scheme (Public or Private).
Even with the availability of various insurance schemes. According to reports, an estimated 6 crore people are impoverished due to catastrophic health expenditure.
