India National News

PMJAY Falls Short, Hospitals Suspected Of Overbilling: Chhattisgarh Study

According to a report from The Hindu A study in Chhattisgarh looked at how well the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (PMJAY) is working. Chhattisgarh demonstrates that the programme has not resulted in a rise in the use of hospital services. Furthermore, hospitalised patients’ out-of-pocket expenses (OOPE) were not decreased by the programme. The information also suggested that hospitals might “double-bill,” which is the practice of collecting money from insurance companies while secretly invoicing patients for the same services. The conclusions are based on a study by the State Health Resource Centre in Chhattisgarh.

Table 1 displays the percentage of people in Chhattisgarh who were part of different Public Funded Health Insurance (PFHI) schemes in 2004, 2014, and 2019.

In 2004, there were no PFHI schemes available. By 2014, approximately 40% of the population had enrolled in a PFHI scheme, and this number rose to 68% by 2019.

The report examined enrollments in three PFHI schemes introduced in the state over the years: Rashtriya Swasthya Bima Yojana (RSBY), PMJAY, and MukhyaMantri Swasthya Bima Yojana (MSBY). RSBY, initiated in 2008, was later merged into PMJAY. PMJAY, launched in 2018 and backed by the central government, is aimed at poor households. MSBY, fully funded by the state government, provides coverage for non-poor households.

As depicted in Table 2, by 2019, PMJAY covered approximately 46% of individuals in the state, whereas MSBY covered less than half of that amount. Additionally, PMJAY offered a significantly higher annual insurance coverage compared to MSBY.

Table 3 illustrates that the proportion of the population accessing hospitals grew between 2014 and 2019. However, the increase was similar among those enrolled in PFHI schemes (rising from 3.3% to 6%) and those not enrolled (increasing from 2.9% to 5.7%). This indicates that PMJAY did not lead to a rise in accessibility.

In Table 4, it’s observed that the percPMJAY Falls Short, Hospitals Suspected Of Overbilling: Chhattisgarh Studyentage of hospitalizations occurring in private hospitals notably rose among individuals enrolled in PFHI schemes, increasing from around 33% to 45% between 2014 and 2019. Conversely, among those not enrolled in such schemes, this percentage decreased from about 54% to 29%.

Table 5 outlines the median out-of-pocket expenditure (OOPE) in rupees for hospitalizations among individuals enrolled in various schemes across 2004, 2014, and 2019. Only OOPE for medical reasons were considered, excluding spending on transportation and accommodation. Comparisons were primarily drawn concerning private healthcare providers due to significantly higher expenses incurred compared to public facilities.

Interestingly, there was no substantial difference between the mean OOPE among those enrolled in PMJAY and those not enrolled. Both groups of patients spent approximately 20,000 rupees per hospitalization episode in private hospitals.

Even when considering the median out-of-pocket expenditure (OOPE), the difference wasn’t significant. Those enrolled spent around 27,300 rupees per hospitalization episode, whereas those not enrolled spent 78,750 rupees.

Table 6 displays the percentage of hospitalizations resulting in catastrophic health expenditure (CHE25), where OOPE amounted to approximately 25% of the patients’ annual expenditure. This percentage remained similar among individuals enrolled in PMJAY and those not enrolled.

Tables 4, 5 and 6 collectively suggest the possibility of double-billing, as OOPE increases despite the rise in insurance coverage.

In conclusion, the findings from the study conducted by the State Health Resource Centre in Chhattisgarh paint a concerning picture regarding the effectiveness of the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (PMJAY). Despite its implementation, there has been no significant increase in the utilization of hospital services, and out-of-pocket expenses for hospitalized patients have not decreased as expected. Moreover, the data raises suspicions of “double-billing” practices by hospitals, where patients may be unfairly charged for services already covered by insurance.

These revelations underscore the need for closer scrutiny and potential reforms within the PMJAY program to ensure that it fulfills its intended objectives of providing affordable healthcare to those in need. Addressing issues such as double-billing and improving accessibility to healthcare services should be prioritized to enhance the scheme’s effectiveness and benefit a broader segment of the population.


Dear Readers,
As an independent media platform, we do not take advertisements from governments and corporate houses. It is you, our readers, who have supported us on our journey to do honest and unbiased journalism. Please contribute, so that we can continue to do the same in future.

Related posts