COVID-19: How the nationwide lockdown impacted PM-JAY, Modi’s Govt’s pet health scheme under Ayushman Bharat

Ten weeks of lock down imposed by the Narendra Modi government has led to a 51% drop in the weekly claims of the Pradhan Mantri Jan Aarogya Yojna (PMJAY) - the government's pet health insurance scheme that covers nearly 50 crore poor.

In terms of the value of the amounts claimed under this government supported medical insurance scheme, the drop is even sharper at 76%.

This is because of a decline in higher cost packages like surgery. Planned surgeries like cataract operations and joint replacements suffered a decline of over 90%.

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By analysing the claim patterns during the lock-down period and comparing the trend with the claims made in the previous 12 weeks, a team of researchers at the National Health Authority found a sharp drop in the institutional admissions for child delivery and oncology cases. Both are a matter of concern to the public health officials.

In oncology cases, there was a 64% drop for the nation but the numbers rose sharply for Maharashtra and Tamil Nadu, the two states affected most by the COVID-19.

“Increased burden on healthcare infrastructure due to diversion of resources towards COVID-19 response along with fear of infection have resulted in a reduced uptake of Aysuhman Bharat PM-JAY services over the last few months. Particularly, decline in pediatric and oncology package utilization is the most worrisome aspect that has been observed in our study,” Vipul Aggarwal, Deputy CEO, National Health Authority told DH.

The steepest decline in claim volume – over 75% - was seen in Assam, Maharashtra and Bihar whereas smaller drops – 25% or less - was observed in Uttarakhand, Punjab and Kerala. In Karnataka, the claims declined by nearly 62%.

There was a 57% decline in utilization of surgical procedures than medical cases (46%). This is to be expected, since surgeries are more commonly planned in advance, whereas medical cases are not. The claims for hemodialysis, an essential life-saving treatment, was lowered by only 6% during lockdown, far less than for most other procedures.

Overall the claims from government hospitals reduced during the lock-down period possibly because many such hospitals were converted to COVID-19 centres by the government and there were few staff to do the paperwork required for the PM-JAY scheme.

Also hemodialysis being the most utilized PM-JAY package, there was a shift in the claims as most people availed the service at private hospitals.

"The number of 'active' hospitals – those submitting at least one claim during a week – fell by almost 50% in both the public and private sectors. Activity levels among private hospitals started to recover late in the lock-down but remained low among public hospitals,” says the NHA report, giving an indication how the pandemic bulldozed everything else in the healthcare system.

"We are making all possible efforts to spread awareness regarding COVID-19 and encourage patients to avail required services under the scheme. To further augment the availability of healthcare services, we have empanelled more than 2200 hospitals since April 2020,” Agarwal said.

PM-JAY is the principal component of the Modi government’s flagship Ayushman Bharat scheme to address the healthcare needs of the economically backward section of the society. The other half of the scheme is to convert lakhs of sub-centres in the villages into wellness centres.