The “Pradhan Mantri Jan Arogya Yojana (PMJAY) Policy Brief (8): PMJAY Under Lockdown: Evidence on Utilization Trends” reveals that the nationwide lockdown resulting from the COVID-19 pandemic has had a notable negative effect on inpatient care utilization under the PMJAY scheme. This examination of the impact encapsulates 22 weeks of data, ranging from the first day of January to the second of June in 2020. The national lockdown officially commenced on March 25th and eventually experienced significant relaxations by June 1st. For this analysis, claim data from the PMJAY Transaction Management System (TMS) was utilized, with non-rejected pre-authorisation requests serving as the main indication of claim volumes.
About the Pradhan Mantri Jan Arogya Yojana Program
This Indian government-sponsored health insurance program provides an insured sum of Rs. 5 lakh per family to cover secondary care not involving a super-specialist, as well as tertiary care requiring a super-specialist’s attention. It is an entitlement-based plan, targeting beneficiaries determined by the most recent Socio-Economic Caste Census (SECC) data. Once identified, the beneficiary is considered insured and can access treatment at any empanelled hospital. The cost of insurance is usually split between the central and state governments in a 60:40 ratio. Packaged rates include all services so that individual services are not charged separately.
Key Points of Impact due to Lockdown
Various demographic groups, including women, younger and older populations (below 20 and above 60), reduced their utilization more than men, young adults, or middle-aged individuals. Scheduled surgical procedures like cataract operations and joint replacements witnessed a drastic decline of over 90%, whereas hemodialysis lowered by only 20%. Overall, the average weekly claim volumes during the ten weeks of the lockdown were 51% lower than the weekly average before the lockdown period.
Region-wise Effects
The most considerable decline, over 75%, was observed in Assam, followed by Maharashtra and Bihar, while Uttarakhand, Punjab, and Kerala experienced smaller decreases, only around 25%. A marginal but noticeable shift occurred in PMJAY utilization, moving from public to private hospitals.
Significant Declines in Certain Areas
There were notable decreases in admissions for child delivery and oncology treatments. The utilization of neonatal packages dropped by 24%. There was a minor shift from public to private health facilities for neonatal care, with significant declines observed in the public sector in Tamil Nadu and Madhya Pradesh.
Effects on Oncology
A 64% drop in oncology volumes across India was concentrated in a few states. The public sector experienced a 90% decrease in claims in Maharashtra and a 65% reduction in Tamil Nadu. This is especially noteworthy since the public sector plays a minor role in oncology care under PMJAY.
Reasons for Decrease in Utilization
The decrease can be attributed to various factors. On the supply side, hospitals could have been overwhelmed due to COVID-19 preparations or caseloads, resulting in fewer resources for non-COVID-19 cases. This is particularly valid for public hospitals. Private hospitals may reduce services because of fear among health workers of getting infected. On the demand side, beneficiaries might delay or forego treatment due to fear of infection at a hospital, difficulties reaching hospitals due to public transport shutdowns and mobility constraints, or financial considerations related to seeking care during the economic crisis.
Health experts emphasize that minimizing the impact on key health programs will be an ongoing challenge that requires continuous close monitoring.
