Address problems in working of PM-JAY

The many irregularities and shortcomings pointed out by the Comptroller and Auditor General (CAG) in the working of the Ayushman Bharat-Pradhan Mantri Jan Arogya Yojana (PM-JAY) have given rise to concerns over the management and implementation of the programme. It is an important programme intended to provide medical insurance cover to people in the lower strata of society and thus serves a vital need. But the report, tabled in parliament last week, has noted many problems in the database, such as invalid names, duplicate health IDs, incorrect entries in gender fields, unrealistic family sizes, and improbable dates of birth. The CAG’s scrutiny also found many cases of treatment for patients who had already been declared dead, and thousands of people using the same Aadhaar number or invalid mobile phone number. About 7.5 lakh people in the database were linked with a single mobile number, 1.4 lakh to another number, and about one lakh to yet another. Thousands of registrations were made against same Aadhaar numbers.

The authorities have claimed that these do not point to any irregularities as mobile numbers do not play any role in the verification of beneficiaries and often dummy numbers are used. But there are many other inconsistencies and oddities which are not easily explained. There are many cases of duplication of the alphanumerical ID of the beneficiaries. There are beneficiaries who were born in the 19th century, and dead patients have got the benefit. Each family gets an insurance cover of Rs 5 lakh. But the average cost of hospitalisation is just over Rs 13,000. This appears to be much below the normal expenditure incurred for hospitalisation. The report has also mentioned other problems like private hospitals performing procedures reserved for public hospitals and systemic issues like shortages of infrastructure, equipment and doctors at empanelled hospitals and cases of medical malpractice.

PM-JAY is the world’s largest health insurance programme, which covers about 110 million families and about 40 per cent of the country’s population. There are bound to be large numbers of lapses, slip-ups, errors, cases of fraud or corruption in such a big programme. But the CAG report does not point to the occurrence of such individual cases but of problems in the design and implementation of the programme. The report also shows infrastructure needs to improve, especially in backwards states like Bihar, where the public health machinery and facilities are very inadequate. There may also be issues other than those uncovered by the CAG. The PM-JAY is five years old, and it has not had a proper scrutiny till now. The CAG report should prompt the government to address its shortcomings and to improve its working.