Why Ayushman Bharat-PMJAY claim volume has declined up to 75% in Maharashtra, other states

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Published: June 23, 2020 1:59 PM

Ayushman Bharat PMJAY: The steepest decline of over 75 per cent was witnessed in Maharashtra, Assam and Bihar. Incidentally, the number of COVID-19 cases in Maharashtra is highest among all states of India while the number of cases in Bihar and Assam has gone up considerably in the last few weeks.

ayushmaan bharat pmjayThe NHA has observed that there was a very small decline (up to 25 per cent) in states like Uttarakhand Kerala and Punjab.

There has been a severe impact of national lockdown on the utilization of inpatient services under Ayushman Bharat- Pradhan Mantri Jan Aarogya Yojana (AB-PMJAY). A policy brief issued by the National Health Authority (NHA) says that the average weekly claim volumes during the 10 weeks of lockdown were 51 per cent lower than the weekly average observed during the 12 weeks prior to the lockdown. The decline in the value of claims was even steeper during the lockdown. As per the NHA study, there has been a wide variation in the claim volume across states. The steepest decline of over 75 per cent was witnessed in Maharashtra, Assam and Bihar. Incidentally, the number of COVID-19 cases in Maharashtra is highest among all states of India while the number of cases in Bihar and Assam has gone up considerably in the last few weeks.

The NHA has observed that there was a very small decline (up to 25 per cent) in states like Uttarakhand Kerala and Punjab. As of today, the number of coronavirus cases in these states has not gone beyond control. According to the Ministry of Health and Family Welfare, the number of active cases in Punjab, Kerala and Uttarakhand is 1309, 1540 and 853 respectively. In contrast, Maharashtra, Bihar and Assam have 61807, 1989 and 2956 active cases respectively.

Why PMJAY claim volume declined in lockdown

Explaining the reason behind the decline, Dr. Vipul Aggarwal, Deputy CEO, National Health Authority, told FE Online that prime reasons for reduced PMJAY clams are: increased burden on the healthcare system due to COVID-19, diversion of resources towards COVID-19 care and fear of infections.

“Increased burden on healthcare infrastructure due to diversion of resources towards COVID response along with fear of infection has resulted in reduced uptake of AB PM-JAY services over the last few months,” Dr Aggarwal said.

The NHA Deputy CEO finds that the decline in pediatric and oncology package utilisation is a quite worrisome trend of the national lockdown.

“Particularly, decline in pediatric and oncology package utilization is the most worrisome aspect that has been observed in our study. We are making all possible efforts to spread awareness regarding COVID 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,” Dr Aggarwal said.

The NHA study has also found that more number of women, younger and older populations (under 20 and over 60) reduced their utilisation of AB-PMJAY as compared to men. There was also a “small but perceptible” change towards utilisation of PMJAY from the public to private hospitals.

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