Issues in implementation of PM-JAY

Source-This post on Issues in implementation of PM-JAY has been created based on the article “Does PMJAY need a design change?” published in “The Hindu” on 2 May 2024.

UPSC Syllabus-GS Paper-2- Issues Relating to Development and Management of Social Sector/Services relating to Health.

Context-The article highlights the challenges faced by the PM-JAY and analyses the need to bring changes in its design from an expert point of view.

What is Ayushman Bharat Scheme?

Ayushman Bharat is the government’s flagship program aimed at achieving universal health coverage (UHC) in India, launched in 2018.

Read more- Ayushman Bharat-Pradhan Mantri Jan Arogya Yojana

What are the issues faced by PM-JAY?

1) Hospital Dues– Certain hospitals in particular states have raised grievances about being owed large sums of money by PM-JAY.

2) Issues with design– PM-JAY was not intended to provide complete universal health coverage or cover all healthcare costs, as it currently makes up less than 2.5% of total health spending in India.

3) Misuse of resources-There is misuse of government resources which increases inefficiencies in the public healthcare system

4) Demand-side perspective-People often choose private hospitals over public hospitals due to the perception of better-quality care due to issues like capacity constraints, delays in claim payments, claim rejections etc. In public hospitals.

5) Performance Disparity among States– The performance of states under PM-JAY varies significantly in terms of coverage, dispersion of hospitals, governance processes. This is because of factors like hospital capacity, network adequacy, and the role of the public sector in ensuring healthcare access in underserved areas.

What should be the way forward?

1) Design change– There is an urgent need to make potential design changes to make PM-JAY more sustainable and effective in achieving its objectives.

2) Strengthen public health sector– There is a need to improve the public health sector by dealing with limited resources and creating systems that encourage healthcare providers and patients to support universal health coverage.

3) Enhancing Government Healthcare Spending- There is a need to include pooling government healthcare expenditures and separating the roles of payers and providers in healthcare.

4) Diverse Approaches to Influence Healthcare Behavior– Rather than just focusing on pricing, there needs to be an emphasis on other mechanisms to influence the behavior of healthcare providers and patients. Additionally, state government programs that can complement and support the goals of PM-JAY should be explored

5) Addressing Out-of-Pocket Expenditure– There is a need to develop system where outpatient care, diagnostics, and drugs can be covered to reduce out-of-pocket expenses further.

Question for practice

Highlight the issues faced by PM-JAY? What steps can be taken to address this?