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Source-This post on Chhattisgarh Study on PMJAY is based on the article “PMJAY did not reduce patients’ health expenses: Chhattisgarh study” published in “The Hindu” on 6th May 2024.
Why in the News?
Recently, a study was conducted in chattisgarh on PMJAY which revealed that the program has not increased hospital service usage. It has also not reduced out-of-pocket costs (OOPE) for hospitalised patients.
The report studied enrolments in three PHFI schemes, Rashtriya Swasthya Bima Yojana (RSBY), PMJAY and Mukhya Mantri Swasthya Bima Yojana (MSBY) introduced in the state across various years.
Key Findings from Chhattisgarh Study on PMJAY
i) Ineffective in Reducing Out-of-Pocket Expenditures: The Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (PMJAY) in Chhattisgarh did not decrease the out-of-pocket expenditure for hospitalised patients.
ii) No Increase in Hospital Utilization: Data shows that the scheme did not lead to an increased utilization of hospital care among the enrolled individuals compared to those not enrolled. In Chhattisgarh, enrollment in Public Funded Health Insurance schemes increased from 40% in 2014 to 68% in 2019, with no such schemes existing in 2004.
iii) Issue of Double-Billing: The study suggests the occurrence of double-billing where hospitals may be claiming payment from the insurance scheme and also charging patients directly for the same services.
iv) Insurance Coverage and Hospital Access: From 2014 to 2019, hospital access in Chhattisgarh increased similarly for both insured (3.3% to 6%) and uninsured individuals (2.9% to 5.7%), indicating that Public Funded Health Insurance (PFHI) schemes like PMJAY have not significantly improved access.
v) Private vs Public Hospitalizations: The study shows that hospitalizations at private hospitals increased for insured patients and decreased for the uninsured.
Specifically, among those enrolled in PFHI schemes, the rate of hospitalizations in private hospitals rose from about 33% to 45% between 2014 and 2019. Among those who were not enrolled, this share reduced from about 54% to 29%.
Read more: Issues in implementation of PM-JAY
UPSC Syllabus: Schemes and programmes
