PMJAY is way forward to save poor from adverse health effects; here’s what govt must do

Published: December 4, 2019 4:26:08 PM

The National Statistical Office released a report ‘Social Consumptions in India: Health’ on 23 November 2019 which gives estimates of ailing persons, hospitalizations and expenditure incurred on treatment.

The spokesman said, "Rs 70 crore will be used to procure machinery and equipment for the government medical college and its associated hospital."The report is based on a sample survey conducted from July 2017 to June 2018 covering about 1.14 lakh households across the country.
  • By Rattan Chand

The National Statistical Office released a report ‘Social Consumptions in India: Health’ on 23 November 2019 which gives estimates of ailing persons, hospitalizations and expenditure incurred on treatment. The report is based on a sample survey conducted from July 2017 to June 2018 covering about 1.14 lakh households across the country. According to the survey, 7.5 percent of the people suffered from any ailment during 15 days preceding the date of survey. This means that during the said reference period of 15 days, over 10.1 crore people were ailing in India out of the total population of about 135 Crore. The average per ailment treatment cost (as OPD) was estimated at Rs. 636 indicating that an amount of Rs. 6440 Crore was spent on the treatment in a 15 days period or about Rs. 157, 000 crore in a year.

The survey also estimated that 2.9 percent of the people were hospitalized during July 2017-June 2018, meaning that 3.92 crore hospitalizations occurred during this period. The estimated treatment cost per hospitalization estimated by the survey was Rs. 20135 indicating that an amount of about Rs. 79, 000 crore was spent on hospitalized treatments. The annual OPD and hospitalization treatment cost comes to a whopping Rs 2.36 lakh crores, approximately 1.2% of GDP.

There is a large number of poor in India who cannot afford the OPD and the hospitalization treatment costs. It is a known fact that poverty is a major cause of ill health and also a barrier to access to health care. The out of pocket spending not only includes spending on doctors’ consultations, diagnostic tests, and medicine, but also the transportation costs and informal payments to providers. The illness causes considerable loss of income to the ailing persons and the family members who may have to stop working to take care of the ill relative. The poor families are forced to sell assets to cover medical expenses and to borrow at high-interest rates leading to their indebtedness.

The country needs a strong health care delivery system to protect the poor from the potentially catastrophic effects of out-of-pocket health care expenditure. Both the public and private sectors need to be involved in the delivery of health services as 70 percent of the OPD treatments and 58 percent hospitalizations occurred in the private sector, according to the survey.

The government has taken many steps to remedy the situation. One such step is to establish 1,50,000 Health and Wellness Centers (HWCs) across the country by 2022. At these HWCs, one mid-level service provider (Community Health Officer) will be positioned along with Multipurpose Female Worker and ASHAs. These HWCs, mostly in villages or urban slums, will provide OPD and extension services to the population. These HWCs will also encourage people to adopt healthy habits like regular exercise and Yoga.

In order to give protection against the hospitalization expenditure, the government has launched the Pradhan Mantri Jan Arogya Yojana (PMJAY) which will cover about 50 crore rural and urban poor. PMJAY provides cashless and paperless access to hospitalization services and covers medical and hospitalization expenses for almost all secondary and tertiary care procedures.

The scheme is being implemented in 32 States and Union Territories. So far about 21 thousand public and private hospitals have been empanelled and 64 lakh people have got the benefit. Based on the hospitalized cases so far, the treatment cost per hospitalization comes to Rs. 16108 compared to Rs.20135 estimated by the NSO. In order to cover 50 crore targeted poor, it is estimated that an amount of Rs. 23357 crore is required annually by the government, compared to the 2019-20 budget provision of Rs. 6400 crore.

For the success of the PMJAY, it is important that the eligible patients requiring hospitalization get immediate hospitalization approvals and timely payments are made to the empanelled hospitals for the services rendered. The scheme needs to be operationalized fully to cover all the intended beneficiaries. Further, for those not covered under PMJAY (middle class), there is a need to standardize the health insurance premiums so that they can get the insurance coverage at uniform rates. To begin with, the insurance companies and hospitals can be asked to strictly follow the PMJAY empanelled hospital rates.

Other steps to reduce out of pocket expenditure include i) regulating irrational drug prescriptions, diagnostic and drug prices, opening more PM Jan Aushadi Stores, strengthening referral systems, improving the quality of health providers, providing services closer to the habitations of the poor, etc. The availability of doctors at health facilities, empathy towards patients, availability of drugs and diagnostics requires special attention to enhance the credibility of the public health facilities.

The challenge of malnutrition among the poor also needs to be addressed though the Government has recently launched the National Nutrition Mission to improve nutritional outcomes for children, pregnant women, and lactating mothers. While the government has launched many programmes, there is an urgent need to enhance the credibility and efficiency of delivery systems to save the poor from adverse ill health effects.

(The author is Director, EGROW Foundation. The views expressed are the author’s own)

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