PMJAY Withered On The Vines In This Pandemic

by Shatakshi Gupta

The central government claims that Pradhan Mantri Jan Arogya Yojana is the world’s largest public health scheme. Under this scheme, an insurance card is made for every member of a financial weaker family and on this card treatment, up to five lakh rupees is free. Apart from the government hospital, if the treatment is done in a private hospital, then under this scheme five lakhs will be paid by the insurance company.

But now the question arises, how useful this card isfor the treatment of the corona in the country? Did the patients get admission to private hospitals on the basis of this card or the insurance company gave a claim on getting treatment at their level?

Recently, many videos and posts are surfaced on social media, showing that hospitals are denying to admit patients on the Ayushman card. Before, going into further discussion, it is important to understand this flagship scheme.

What is the PMJAY scheme?

Pradhan Mantri Jan Arogya Yojana under Ayushman Bharat is the world’s largest health insurance scheme. Under which insurance card is provided to every low-income household and treatment up to five lakh rupees per year is free. More than twenty thousand hospitals in India are empanelled under this scheme. According to the central government, more than one thousand diseases have been covered in this scheme.

According to the National Health Authority, on 12 May itself, 12377 new Ayushman cards were created in the country. Till May 16 this year, a total of 15.89 crores Ayushman cards have been issued in the country. While so far, a total of 1,74,44,899 hospital admissions have been done under this scheme.

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Challenges during COVID

Information about how many people have received COVID treatment under the PMJAY is not available publicly. When the National Health Authority (NHA) officials were talked about this, they said that data has not been collected yet because COVID treatments are still going on since last year.

However, in an interview, Dr. Vipul Aggarwal, deputy CEO of Ayushman Bharat, told that since the beginning of the COVID-19 pandemic, 4 lakh COVID infected people have been treated under the Ayushman India PMJAY and one million tests were done. 

 Now comes the payment throughinsurance card at the hospital. Health is a state subject and the central government has given states the right to decide packages and rates under PMJAY.

 During the second wave of Corona, treatment in private hospitals became very expensive. In many cities, patients had to pay up to fifty thousand rupees daily for ICU beds. In such a situation, why would any hospital agree to give beds under Ayushman Bharat for just 5 thousand rupees? The rates for treatment in private hospitals set under the scheme are much lower than the rates of hospitals during COVID.

 Even if the CEO of Ayushman Bharat is to be believed that till April this year, 4 lakh COVID patients across the country were treated under PMJAY, it is still very less when compared to the huge poor population of this country and the number of infections in India. So far, around 2.5 million cases of corona infection have been reported in the country.

Does this failure makes this scheme incompetent?

Although, PMJAY is not being very successful during thisepidemic, but this scheme has the potential to provide better health care to the most needed section of this country. There is a health emergency in the country, so no scheme should be judged only on the basis that it was not effective during the health emergency.

But this failure definitely gives a lesson to policymakersthat when the Health Emergency came, this ambitious plan proved futile.  Even the poor for whom it was built, could not get the benefit of it.

During the COVID, the need of the people was that their test should be done near home, the hospital should be available in the vicinity, this could not be done under this scheme. The government will have to take more steps to improve the present health infrastructure.Besides, more stringent norms are required for the treatment through the card in empanelled hospitals.