In light of the recent performance audit report by the Comptroller and Auditor-General of India (CAG), questions have been raised about the implementation and functioning of the Ayushman Bharat-Pradhan Mantri Jan Arogya Yojana (PMJAY). These concerns have highlighted aspects ranging from billing for treatment of dead patients to systemic failures in the system and even unrealistic household sizes.
Clarification on Issues Raised by CAG
Upon review, the CAG’s report had several noteworthy findings that highlighted potential issues with PMJAY. The primary concerns included the treatment of supposedly “dead” patients, unverified and unrealistic household sizes, pensioners benefiting from the scheme, system failures leading to malpractice, and inadequate record keeping, which resulted in pending penalties and issues with data collection.
However, the government has issued clarifications. For instance, on the matter of ‘mobile numbers and verification’, the Ministry of Health has assured that mobile numbers are not used for beneficiary verification, but for communication and feedback purposes.
About the Ayushman Bharat-Pradhan Mantri Jan Arogya Yojana (PMJAY)
Launched in February 2018, PMJAY is a government financed health insurance scheme that stands as the world’s largest. With an insurance cover of up to Rs.5 lakh per family for secondary care and tertiary care, the scheme covers surgery, medical and day care treatments along with the cost of medicines and diagnostics. The beneficiaries of this scheme are identified based on the latest Socio-Economic Caste Census (SECC) data.
Funding and Nodal Agency
The funding mechanism for the scheme is shared between the center and states depending on the region. For most states, and UTs with their own legislature, the central and state governments share the cost in a 60:40 ratio. However, for Northeast states and select regions like Jammu and Kashmir, Himachal Pradesh, and Uttarakhand the center bears 90% of the cost. For UTs without legislature, the funding is taken up 100% by the central government.
The scheme is administrated by the National Health Authority (NHA), an autonomous entity constituted under the Society Registration Act, 1860. Along with state governments, it aims to ensure effective implementation of PMJAY. At the state level, the State Health Agency (SHA) takes responsibility for the scheme’s implementation.
The Way Forward
In light of the irregularities reported in PMJAY, it has become clear that corrective measures are required. Emphasis needs to be placed on improving beneficiary verification, overseeing hospital functioning and developing robust grievance redressal mechanisms. This is crucial to uphold the scheme’s reputation and for it to serve its intended purpose efficiently.
