Hindu Editorial Analysis : 29-July-2023
India’s healthcare sector is witnessing substantial growth, with both public and private players contributing to its expansion. The Pradhan Mantri Jan Arogya Yojna (PM-JAY), also known as Ayushman Bharat, was launched in 2018 to achieve Universal Health Coverage (UHC). However, a recent private report sheds light on certain challenges in the scheme’s implementation, particularly at Delhi’s Safdarjung Hospital. This essay discusses the key findings of the report, the features of PM-JAY, and suggests measures to enhance the scheme’s effectiveness for the benefit of the poor.
The Indian Healthcare Sector
The healthcare sector in India plays a vital role, generating significant revenue and offering employment opportunities. It comprises two major components: the public and private healthcare systems. While the government’s public healthcare system primarily focuses on basic healthcare facilities in rural areas, the private sector caters to secondary, tertiary, and quaternary care, primarily in urban areas.
The Report’s Highlights
The private report draws attention to two important aspects of the PM-JAY scheme. Firstly, it emphasizes the influential role of treating doctors in determining the medical package and whether a patient will be registered under PM-JAY. Secondly, the report reveals instances of patients being misled about the scheme’s clearance process, causing unnecessary delays in availing benefits.
Contrary to popular belief, the settlement of claims in public facilities was not excessively delayed. About 54 percent of the registered claims were settled, with an average processing time of around 21 days. However, there were indications of a lack of active interest in the scheme by the medical teams in public facilities.
Pradhan Mantri Jan Arogya Yojna (PM-JAY)
About: PM-JAY was launched in September 2018 as a Centrally Sponsored Scheme under the Ayushman Bharat Mission to achieve Universal Health Coverage. Aims and Objectives:
- Strengthen health system preparedness for prevention, detection, and management of illnesses.
- Focus on health infrastructure development, including pediatric care.
- Provide measurable outcomes. Key Features:
- Fully government-funded health insurance scheme with a cover of Rs. 5 lakhs per family per year for secondary and tertiary care.
- Covers pre-hospitalization and post-hospitalization expenses.
- No restrictions based on family size, age, or gender.
- Covers all pre-existing conditions from day one. Eligibility:
- Based on Socio-Economic Caste Census 2011 (SECC 2011) criteria for rural and urban areas.
- Includes families covered in the previous Rashtriya Swasthya Bima Yojana (RSBY). Benefits:
- Offers cashless access to health care services.
- Aims to reduce the financial burden of medical treatment for the poor.
Challenges in Implementation
The report identifies various challenges in the effective implementation of PM-JAY in public facilities:
- Inadequate Incentives for Doctors: The current incentive structure may not encourage doctors to actively register patients under the scheme.
- Inadequate Incentives for Arogyamitra: The supporting staff responsible for registering patients lacks sufficient motivation to follow up on claims, leading to potential delays in settlements.
- Vested Interests: Information asymmetry between doctors and patients can result in some patients being denied benefits, serving the interests of certain parties.
Suggestions for Improvement
To enhance PM-JAY’s effectiveness and reach more deserving beneficiaries, several measures can be taken:
- Improving Incentive Structure: Addressing the incentive structure within public facilities can motivate doctors to actively participate in the scheme.
- Generating Active Interest: Encouraging public facilities to take an active interest in PM-JAY can lead to increased revenue, which can be reinvested in infrastructure and amenities.
- Infrastructure Development: Investing in improved infrastructure will enable facilities to cater to more packages and expand health coverage for the poor, while ensuring eligibility database accuracy.
- Government Role: State governments should play a complementary role by providing adequate manpower and ensuring accountability for higher service volumes in public facilities.
Why In News
In a shocking revelation, a confidential report has surfaced, accusing individuals of orchestrating a scheme to sidestep Ayushman Bharat and exploit vulnerable patients at Delhi’s Safdarjung Hospital. The alleged deceitful tactics employed by certain parties have raised serious concerns about the well-being and access to healthcare for the underprivileged in the region.
MCQs about Strengthening PM-JAY for Inclusive Healthcare in India
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What is the main objective of the Pradhan Mantri Jan Arogya Yojna (PM-JAY)?
A. To provide free healthcare services to all citizens in India.
B. To achieve Universal Health Coverage (UHC) in India.
C. To strengthen the private healthcare sector in India.
D. To offer cashless access to health care services for urban families.
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What is the primary challenge faced in the implementation of PM-JAY in public facilities, as per the essay?
A. Inadequate infrastructure in public hospitals.
B. Lack of awareness among patients about the scheme.
C. Insufficient financial resources to support the scheme.
D. Inadequate incentives for medical personnel to actively participate.
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How can the scheme’s effectiveness be enhanced, as suggested in the essay?
A. Reducing the cover amount to accommodate more beneficiaries.
B. Introducing age and gender restrictions for enrollment.
C. Addressing incentive structure and operational dynamics within public facilities.
D. Relying solely on private hospitals for better service delivery.
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