Context: The Comptroller and Auditor General (CAG) flagged significant irregularities and corruption in the implementation of the Pradhan Mantri Jan Arogya Yojana (PMJAY), India’s notable health insurance scheme for the underprivileged. CAG report on the Ayushman Bharat scheme reveals irregularities, including invalid mobile numbers and potential fraud. The CAG identified 4,761 registrations that were linked to only seven Aadhar numbers, indicating potential irregularities.
Of the 27,000 hospitals enlisted for Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (PM-JAY) since its inception in 2018, the most recent health ministry data indicates that only 18,783 hospitals are presently active under the scheme.
Key Points
PMJAY Overview
PMJAY, touted as the world’s most extensive health assurance initiative. It aims to offer a Rs 5 lakh health cover per year to economically backward families for secondary and tertiary hospital care.
The scheme targets 107.4 million impoverished households identified in the Socio-Economic and Caste Census (SECC) database.
CAG’s Findings
The audit unveiled grave issues from outdated beneficiary data sourced from the SECC 2011. It is resulting in discrepancies and ineligibility concerns among beneficiaries.
A considerable percentage of beneficiaries—around 30%—are untraceable due to deficient database quality.
Startlingly, the beneficiary list included 110,000 government pensioners. This accounts for worth Rs 28.87 crore availed treatments under PMJAY, along with their families.
The scheme had treated 3,446 patients posthumously, incurring expenses amounting to 6.97 crore, according to government records.
Challenges and Hospital Infrastructures
Many hospitals lacked essential support systems like pharmacies, blood banks, and ICU facilities, failing to comply with NHA mandates.
Hospital availability per 100,000 beneficiaries remained strikingly low in certain states like Rajasthan, Assam, and Uttar Pradesh.
Suggested Solutions
The need to shift focus from health insurance schemes to strengthening the public healthcare system. Strengthening primary and secondary care in public hospitals similar to the model adopted by Thailand is suggestive.
Thailand’s emphasis on public hospitals for primary and secondary care and reserving health insurance schemes solely for tertiary care was cited as a beneficial strategy.
Conclusion
The PMJAY, while aiming to provide essential healthcare support to vulnerable sections, faces critical challenges due to outdated data, irregularities in beneficiary selection, and inadequacies in healthcare infrastructure. The shift towards fortifying public healthcare infrastructure could significantly address the prevailing gaps and elevate the effectiveness of healthcare coverage for the populace.
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