Fix arogya's ailments at structural level

When Prime Minister Narendra Modi launched Ayushman Bharat-Pradhan Mantri Jan Arogya Yojana (PM-JAY), the world’s largest health insurance scheme, in 2018, he said the flagship programme will provide the poorest of the poor with better healthcare and treatment, cover 1,300 illnesses, and that private hospitals will also be part of the programme. The scheme is now facing several hurdles that need to be removed. Latest health ministry data show that of the 27,000 hospitals empanelled since 2018, only 18,783 are active. Among the rest, 4,682 hospitals have been inactive since the start. Also, 3,632 hospitals turned inactive in the last six months, taking the total number of inactive hospitals to 8,314.

PM-JAY offers health cover of up to ₹5 lakh to over 107.4 million poor and vulnerable families (500 million beneficiaries), with free and cashless treatment through a network of private (15,000) and government (12,000)-empanelled hospitals. The absence of a properly functioning healthcare system means that Indians have a very high out-of-pocket expenditure on health, and it impoverishes some 55 million Indians annually. 59% of households do not have any health insurance plan.

PM-JAY is suffering reportedly because hospitals find the treatment package rates low and face delays in claim settlement; authorisation norms are stringent – hospitals are delisted if they fail to raise a single pre-authorisation within six months of its empanelment – and many hospitals do not have required in-patient facilities. These are serious structural issues that need tackling on a war footing since inefficiencies in design and implementation burden poor beneficiaries, who end up delaying treatment or paying themselves, defeating the scheme’s purpose.