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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