Unethical linkages in implementing PMJAY should be checked: Parl panel

A parliamentary committee said on Tuesday that the government should explore a robust monitoring mechanism to keep a check on unjustified profit-making and any unethical linkage between insurance companies and hospitals in the implementation of the PMJAY scheme.

The Department-related Parliamentary Standing Committee on Health and Family Welfare, in its 151st report presented in the Rajya Sabha on Tuesday, suggested that the government should push for the payment of insurance premium in instalments, preferably on a monthly or quarterly basis.

Necessary mechanisms should be in place to ensure that the insurance companies are working in accordance with the objectives and norms of the scheme, it underlined.

The panel also recommended expanding the outreach and base of the beneficiaries to be covered under the Pradhan Mantri Jan Arogya Yojana (PMJAY) scheme gradually till Universal Health Coverage (UHC) is achieved.

Those states where the target set to cover the population under the scheme has not been met should include new categories for 100 per cent targeted coverage, the panel said.

It observed that accurate identification and registration of the eligible beneficiaries under PMJAY is a major challenge.

It is difficult to reach the poorest and most-vulnerable population of the country due to low literacy and awareness. This is true for most lower and middle-income countries (LMIC) and India is no exception. It is essential to ensure that the benefits reach the target sections of the population, the panel said.

It also recommended devising an appropriate mechanism to ensure weeding out of ineligible beneficiaries and identification of eligible beneficiaries in a planned, coordinated and time-bound manner.

It said the ministry and the National Health Authority, along with the implementing states and Union territories, need to undertake a countrywide drive to scrutinise and validate the BIS database.

"Validation checks should be in place to increase the accuracy and reliability of the data. The inconsistencies in the database may be removed at the earliest. The appropriate mechanism may be devised to ensure weeding out of ineligible beneficiaries and identification of eligible beneficiaries in a planned, coordinated and time-bound manner," it said.

The committee further said the states need to be impressed upon to map their own database with the SECC database to avoid duplication.

The process for approval or rejection of ineligible beneficiaries and registration of eligible beneficiaries needs to be made simple and less time-consuming to avoid delay beyond the prescribed time, it said in the report.

As far as the coverage of beneficiaries under the scheme is concerned, the committee was apprised that several beneficiaries were facing problems in addition and inclusion of family members above or below the prescribed number of six.

The ministry said the criterion of six family members is with reference to one mobile phone number and there is no cap on the family size under PMJAY. The committee, therefore, recommended that the difficulties being faced by the beneficiaries having a family of less or more than six members may be addressed promptly by updating the application software.

It also observed that the PMJAY scheme is running either after merging or in parallel with the state governments' schemes.

There are concerns that at the time of implementation, PMJAY, which is the major funding agency, may get the back seat in comparison to the state schemes.

The government is taking steps like co-branding of Ayushman Bharat cards, kiosks etc.

The panel suggested that the Centre should make efforts in right earnest for the convergence of the state schemes with Ayushman Bharat and to give prominence to PMJAY.

The committee further highlighted that preventing and detecting fraud is a significant concern.

Fraudulent practices, such as overbilling and unnecessary procedures, can strain the programme's finances and undermine its goals.

"In view of these facts, the committee is of the opinion that technology is crucial for monitoring and fraud prevention, as all the processes and data are in electronic form. To enhance the evaluation and analysis of available data in PMJAY, the committee recommends establishing a dedicated and skilled IT research team to develop and monitor the technical aspects of IT applications for effective dissemination of information and data analysis," it stated.