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Health Care
In recent years, India's ambitious health insurance scheme, Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY), has faced numerous challenges, including hospitals demanding cash payments from beneficiaries, poor quality of service, and a surge in grievances reported through the program's grievance redress system. Despite its promise to provide cashless hospitalization and alleviate financial burdens on low-income families, the program has struggled to deliver these benefits effectively. In this article, we delve into the issues plaguing AB-PMJAY and discuss potential solutions to improve its implementation.
Launched in 2018, Ayushman Bharat is designed to provide health insurance coverage of up to Rs 5 lakh per family per year for secondary and tertiary hospitalizations. The scheme is managed by the National Health Authority (NHA) and aims to offer immediate health benefits without any waiting period, including coverage for pre-existing conditions. This comprehensive health insurance program targets economically vulnerable sections of society, aiming to reduce out-of-pocket healthcare expenses and improve health outcomes.
A significant issue affecting beneficiaries is the demand for cash payments by hospitals, despite the program's cashless claims feature. Over 74% of hospital service-related grievances have been attributed to hospitals asking for money from patients, which contradicts the scheme's core objective of providing free medical treatment for eligible families[1][2]. This practice not only imposes unexpected financial burdens on beneficiaries but also undermines trust in the healthcare system.
Besides financial issues, complaints about poor service quality are prevalent. States like Chhattisgarh, Jharkhand, and Uttarakhand have reported high numbers of grievances related to hospital service quality[1][3]. Concerns include poor treatment quality, denial of treatment, and lack of essential medicines and diagnostics. These problems highlight the need for improved healthcare infrastructure and accountability within participating hospitals.
Another critical concern is related to eligibility and registration. States such as Maharashtra, Assam, and Bihar have seen high numbers of complaints regarding these issues, often stemming from difficulties in obtaining beneficiary cards[1][3]. In Assam, for example, over 50% of grievances were about eligibility and registration problems, partly due to staff shortages in state health agencies[1][3].
The COVID-19 pandemic has significantly impacted grievance patterns within AB-PMJAY. During the first wave, there was a notable decline in grievances, followed by a substantial increase in subsequent waves[3]. Assam emerged as a state with the highest grievance rate throughout the study period, primarily due to eligibility and registration issues[3].
Addressing the challenges faced by AB-PMJAY requires a multi-faceted approach:
Enhancing Accountability: There is a need for stricter monitoring of healthcare providers to prevent illegal practices like demanding cash payments. The removal of 75 healthcare providers between 2018 and 2021 for such activities indicates that more stringent measures are required[1][2].
Improving Service Quality: Investing in healthcare infrastructure and ensuring that hospitals maintain high standards of care could mitigate service-related complaints.
Streamlining Eligibility and Registration: Simplifying the process of obtaining beneficiary cards and addressing staff shortages in health agencies can help reduce eligibility and registration grievances.
Strengthening Grievance Redressal Systems: Improving data categorization and analysis within the grievance system can help identify specific patterns and areas for improvement.
In an effort to expand health coverage, the government has extended Ayushman Bharat benefits to 1 crore gig workers during the Budget 2025. This move aims to address the health insurance gap faced by gig workers, who often lack stable income and social security benefits[5]. Eligible gig workers can access these benefits by registering on the e-Shram portal using their Universal Account Number (UAN). This initiative not only supports the financial stability of gig workers but also underscores the government's commitment to improving access to healthcare for all sectors of society.
Ayushman Bharat holds the potential to transform India's healthcare landscape by providing affordable health insurance to millions of people. However, addressing the current challenges of hospital cash demands, poor service quality, and eligibility issues is crucial for its success. By enhancing accountability, improving service standards, and streamlining beneficiary registration processes, AB-PMJAY can better meet the needs of its beneficiaries and contribute to achieving Universal Health Coverage in India.
As the program continues to evolve with new initiatives like the extension of benefits to gig workers, it remains essential to monitor and address emerging challenges proactively. This not only ensures the scheme’s effectiveness but also fosters trust among its beneficiaries, which is critical for its long-term success.
