{"id":255810,"date":"2023-08-11T19:39:21","date_gmt":"2023-08-11T14:09:21","guid":{"rendered":"https:\/\/blog.forumias.com\/?p=255810"},"modified":"2023-08-29T13:47:58","modified_gmt":"2023-08-29T08:17:58","slug":"not-quite-healthy-pmjay-has-design-flaws-which-may-limit-its-potential-to-lower-out-of-pocket-expenditure","status":"publish","type":"post","link":"https:\/\/forumias.com\/blog\/not-quite-healthy-pmjay-has-design-flaws-which-may-limit-its-potential-to-lower-out-of-pocket-expenditure\/","title":{"rendered":"Not Quite Healthy- PMJAY has design flaws which may limit its potential to lower out-of-pocket expenditure"},"content":{"rendered":"\n

Source:<\/strong> The post is based on the article \u201cNot Quite Healthy- PMJAY has design flaws which may limit its potential to lower out-of-pocket expenditure<\/strong>\u201d published in \u201cTimes of India\u201d on 11th August 2023.<\/p>\n

Syllabus:<\/strong> GS2- Welfare schemes for vulnerable sections of the population by the Centre and States and the performance of these schemes;<\/p>\n

News:<\/strong> In this article author reviews the five-year performance of Pradhan Mantri Jan Arogya Yojana (PMJAY), India’s health insurance scheme, referencing a CAG report that found database errors. The article also discusses hospital disparities in states and suggests improvements to decrease out-of-pocket costs.<\/p>\n

What does the CAG report say about PMJAY?<\/strong><\/h2>\n
    \n
  1. Data Issues:<\/strong> The CAG report revealed several problems with PMJAY’s data. Notably, the PMJAY Id, which should be a unique 9-digit alphanumeric code, had duplicates. This means multiple beneficiaries could have the same identification, leading to confusion and potential fraud.<\/li>\n
  2. Age Discrepancies:<\/strong> There were inaccuracies related to beneficiaries’ ages. Some of the records showed beneficiaries born in the 19th century, indicating significant errors in the database.<\/li>\n
  3. Impact on Costs:<\/strong> GOI data showed that the average hospitalization cost in 2022-23 was \u20b913,703, which is less than 3% of the total cover of \u20b95 lakh per family. This figure seemed inconsistent with the typical rise in medical expenses, making it a potential concern in the CAG report.<\/li>\n
  4. Need for Stronger Oversight:<\/strong> The report suggests that without proper data and process controls, dubious healthcare providers could exploit the system, emphasizing the need for a tighter grip on information and procedures.<\/li>\n<\/ol>\n

    What should be done?<\/strong><\/h2>\n

    Data Integrity:<\/strong> Rectify database issues, ensuring PMJAY Ids are unique and correct age discrepancies, like those born in the 19th century.<\/p>\n

    Hospital Availability:<\/strong> Increase the number of empaneled hospitals, especially in poorer states like Bihar which, despite having a population exceeding Tamil Nadu by 50 million, has less than half its number of empaneled hospitals.<\/p>\n

    Protect Patients:<\/strong> Address issues in public hospitals where patients are reportedly defrauded or denied PMJAY benefits.<\/p>\n

    State Health Authorities Role:<\/strong> SHAs, being the primary administrators, should enhance their oversight and efficiency.<\/p>\n

    Independent Audit:<\/strong> The government should commission an independent audit to assess PMJAY’s impact on out-of-pocket expenses.<\/p>\n","protected":false},"excerpt":{"rendered":"

    Source: The post is based on the article \u201cNot Quite Healthy- PMJAY has design flaws which may limit its potential to lower out-of-pocket expenditure\u201d published in \u201cTimes of India\u201d on 11th August 2023. Syllabus: GS2- Welfare schemes for vulnerable sections of the population by the Centre and States and the performance of these schemes; News:… Continue reading Not Quite Healthy- PMJAY has design flaws which may limit its potential to lower out-of-pocket expenditure<\/span><\/a><\/p>\n","protected":false},"author":10320,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"jetpack_post_was_ever_published":false,"footnotes":""},"categories":[1230,9],"tags":[212,8131],"class_list":["post-255810","post","type-post","status-publish","format-standard","hentry","category-9-pm-daily-articles","category-public","tag-gs-paper-2","tag-social-issues","entry"],"jetpack_featured_media_url":"","views":{"total":0,"cached_at":"","cached_date":1704664497},"jetpack_sharing_enabled":true,"_links":{"self":[{"href":"https:\/\/forumias.com\/blog\/wp-json\/wp\/v2\/posts\/255810","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/forumias.com\/blog\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/forumias.com\/blog\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/forumias.com\/blog\/wp-json\/wp\/v2\/users\/10320"}],"replies":[{"embeddable":true,"href":"https:\/\/forumias.com\/blog\/wp-json\/wp\/v2\/comments?post=255810"}],"version-history":[{"count":0,"href":"https:\/\/forumias.com\/blog\/wp-json\/wp\/v2\/posts\/255810\/revisions"}],"wp:attachment":[{"href":"https:\/\/forumias.com\/blog\/wp-json\/wp\/v2\/media?parent=255810"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/forumias.com\/blog\/wp-json\/wp\/v2\/categories?post=255810"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/forumias.com\/blog\/wp-json\/wp\/v2\/tags?post=255810"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}