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Source: The post is based on the article “Ayushman Bharat expose: How to nudge India’s public health infrastructure” published in “The Indian express” on 28th July 2023.
Syllabus: GS2- Welfare schemes for vulnerable sections of the population by the Centre and States and the performance of these schemes.
News: The author discusses challenges in the Pradhan Mantri Jan Aarogya Yojana (PMJAY) health scheme. Doctors sometimes misuse the scheme for personal gains. The author suggests better incentives and focus on public facilities to improve the scheme and benefit the poor.
What are the challenges in the Pradhan Mantri Jan Aarogya Yojana (PMJAY) health scheme?
Misuse by Doctors: Some doctors deceive patients for personal gain. For instance, a doctor at Safdarjung Hospital misled patients about the scheme’s timeline.
Financial Incentives: Doctors might choose private channels over the scheme if they gain more financially, like the Safdarjung case.
Settlement Delays: Popular belief suggests long claim settlement times in public hospitals, but in reality, it’s 21 days on average.
Less Active Interest: Public facilities show less interest in the scheme compared to private ones. Only 54% of claims in public facilities were settled.
Staff Overload: Public hospital staff, already handling many clinical activities, find it hard to manage the scheme.
Arogyamitra’s Role: Arogyamitra focuses more on registering patients than on ensuring claim settlements.
Limited Services: Most public facilities offer selected services, reducing potential revenues.
Infrastructure Needs: Better infrastructure and more staff can boost the scheme’s success in public hospitals.
What should be done?
Transparency: Clear information should be provided to patients about the benefits of PMJAY to prevent misuse by doctors.
Increase Incentives: Doctors should receive better incentives for registering patients under PMJAY and settling claims.
Faster Claim Settlements: Streamline the process to reduce the average 21-day claim settlement time in Bihar.
Active Interest: Encourage medical teams in public hospitals to take active interest in the scheme.
Claim Follow-up: Arogyamitra’s pay could be linked to successful claim settlements, not just registrations, encouraging them to follow up.
Revenue Generation: Increase the types of services in public facilities to increase revenue.
State Support: State governments should provide manpower and enforce accountability to increase service volume in public facilities.
Database Correction: Ensure no one is excluded due to database errors in eligibility.
