Pradhan Mantri Jan Arogya Yojana (PMJAY) is the world’s largest health insurance/ assurance scheme fully financed by the government. It envisions to help mitigate catastrophic expenditure on medical treatment which pushes nearly 6 crore Indians into poverty each year. Some of the key features of the scheme are:
- It provides a cover of Rs. 5 lakhs (500,000) per family per year for secondary and tertiary care hospitalization across public and private empaneled hospitals in India.
- It provides cashless access to health care services for the beneficiary at the point of service, that is, the hospital.
- It covers up to 3 days of pre-hospitalization and 15 days post-hospitalization expenses such as diagnostics and medicines.
- There is no restriction on the family size, age, or gender.
- All pre–existing conditions are covered from day one.
- Benefits of the scheme are portable across the country. A beneficiary can visit any empaneled public or private hospital in India to avail cashless treatment.
- Services include approximately 1,393 procedures covering all the costs related to treatment.
The scheme has benefited a large number of individuals and families since its launch. However, the full potential of the scheme is yet to be unlocked. Information asymmetry seems to be a major hinderance for the target population, in availing the benefits of the scheme. At least this is what our experience in one of the projects indicates.
As on December 12, 2022, a total of 179 million Ayushman cards have been created. Madhya Pradesh (33.6 million), Uttar Pradesh (23.3 million), and Gujarat (16.4 million) are the top three states by the number of cards created. However, authorized hospital admissions are the highest in Tamil Nadu, Kerala, and Rajasthan. Prima facie, the number of hospital admissions seems to be correlated to the number of empaneled hospitals. Tamil Nadu has the highest number of empaneled hospitals. The correlation with this logic ends here. The second and third largest number of empaneled hospitals is in Karnataka and Uttar Pradesh.
Assuming that the data on Ayushman Bharat provided in Pradhan Mantri Jan Arogya Yojana (PMJAY) website is error free, and assuming that a few hospitals are not reporting inflated/ fake data of admissions; a probable explanation for low use of Ayushman Bharat cards is some states is the low levels of awareness among the card holders. This is corroborated by our experience in one of the districts in North India, where we have witnessed cases of people not being able to avail of free treatment due to non-linkage with Aadhaar number.
Our quest to understand more about the issues faced by the target population, led us to two neighboring families who had completely opposite stories to narrate. One of the families had put away their Ayushman card in a trunk after they received it. A few months later when one of the children fell il, they searched for it and took it to the hospital where they child was taken for treatment. However, they were denied the cashless treatment as the child’s Aadhaar number was not linked to the card. The neighbors had similar situation when one of the family members had a fractured leg and needed a surgery. The person’s Aadhaar was also not linked to the Ayushman card. However, they had the flexibility to delay the surgery. They immediately applied for update for Aadhaar number, which was updated within a week. Surgery was carried out and they saved about Rs.150,000.
In both cases the card holders were not aware that there is a basic condition of linking of Aadhaar number with the card. Similarly, many people are not aware of the diseases that are covered, or the nearest empaneled hospital. Although, IEC material has been developed for customer awareness
PMJAY has an information, education, and communication (IEC) component. However, its effect on the ground is not visible. Most recipients of the card are not aware about the eligibility criteria, its usage, terms & conditions, and empaneled hospitals etc. There is a need to have a proper structure for two-way communication: (a) mass awareness creation, and (b) to take feedback from the target population so that targeted delivery is continuously improved, and pain points are addressed. To make things simpler for the officials and the citizens, camps can be set up from time-to-time in different locations for linking of Aadhaar with Ayushman cards, with prior announcement about the same. Also, to increase awareness and take the message to the younger generation, who are quite eager to learn and are able to influence their parents and elders to a great extent, government can organize competitions such as quizzes, drawing/painting, debate etc. in schools and colleges. These additional activities will strengthen the program on the foundations of a well-informed and aware target population.