Study by researchers from State health resource centre in Chhattisgarh analysed PM-JAY implementation | Current Affairs | Vision IAS
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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.

 

  • Tags :
  • PMJAY
  • Ayushman Bharat
  • Out of pocket expenditure
  • Health insurance
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