Ayushman Bharat: Patients prefer private hospitals for govt schemes

Despite accounting for 46% of hospital empanelments, private hospitals accounted for 54 per cent of 38 million hospital admissions under AB-PMJAY

Government hospitals constitute 54 per cent of 28,311 empanelled under the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY), but a Business Standard analysis found that hospitalisations in private hospitals exceed their government peers.
  
Despite accounting for 46 per cent of hospital empanelments, private hospitals accounted for 54 per cent of 38 million hospital admissions under AB-PMJAY.
  
The average claim size, according to the ministry’s annual report of the scheme, was 51 per cent higher in private hospitals at Rs 13,730 per person, compared to Rs 9,045 in public hospitals.
  
Four years since it was launched, the scheme has issued 190 million cards. It is operational across 33 states and Union Territories. Delhi, Odisha, and West Bengal are yet to resume the scheme.
  
The scheme aims to provide cashless and paperless health care benefits. It provides a health cover of Rs 5 lakh per family per year of post-hospitalisation expenses.

Further analysis shows that some of the poorer states have not been able to take advantage of the scheme and the benefits have accrued to wealthier states and those with better health infrastructure. Kerala, for instance, had the highest bed availability per 1,000 people in empanelled hospitals under AB-PMJAY among larger states at 5.3. Bihar and Rajasthan had the worst ratios at 0.8 and 0.4.
  
Surprisingly, Bihar had the highest claims ratio among the larger states as the state paid 89.3 per cent of the claims. Rajasthan was still a laggard with 2.5 per cent claims paid.
  
Older people and females have also not been able to utilise the benefits efficiently. Males accounted for 52 per cent of hospital admissions. The ratio of people hospitalised in the 30-44 age group at 24 per cent was higher than the 22 per cent hospitalisation in the 60 plus age group. The hospitalisation share of the 15-29 age group was 21 per cent.

Fund utilisation under the scheme has also lagged. Of the Rs 19,200 crore budgeted for the scheme between 2019-20 and 2021-22, just 46 per cent or Rs 8,832.5 crore was utilised or released.
  
The government’s performance as regards Ayushman Bharat Digital Mission (ABDM) has been laudable. “The mission crosses the landmark of 10 million digitally linked health records with over 27 lakh records linked in a day,” Union Minister Union Health Minister Mansukh Mandaviya tweeted on Sunday.
   
ABDM took 620 days to link the first 1.5 million health records and is now linking more than 15 lakh health records every day, the ministry reported.