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Ayushman Bharat beneficiaries chose pvt hospitals over govt during lockdown due to Covid fear

A govt analysis of the 10-week lockdown period showed that claims under PM-JAY health insurance scheme fell by 51% compared to the 12 weeks before it.

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New Delhi: Beneficiaries of the world’s largest health insurance scheme, Ayushman Bharat, preferred private hospitals over public hospitals since the start of lockdown, as they feared the spread of Covid-19 more in government hospitals, according to an analysis conducted by the central government.

The use of the Ayushman Bharat scheme, formally known as Pradhan Mantri Jan Arogya Yojana (PM-JAY), fell to half during the 10 weeks of the lockdown, according to the analysis conducted by its implementing agency, the National Health Authority.

The NHA analysed in-patient care patterns based on Ayushman Bharat claims, and found that there was a steeper decline in utilisation of public hospitals than private hospitals.

“Overall, average weekly claim volumes during ten weeks of lockdown were 51 per cent lower than the weekly average observed during the twelve weeks prior to the lockdown,” it stated.

The NHA’s policy brief document, accessed by ThePrint, also stated that among the beneficiaries of Ayushman Bharat — the poorest 40 per cent of the population — “there is little evidence of a surge in Covid-19 caseloads, at least on a national level”.

However, the 11-page document, titled ‘PM-JAY Under Lockdown: Evidence on Utilisation Trends’, added that “the future course of the pandemic in India remains highly uncertain”.

Also read: Covid-19 opportunity for India to speed up Ayushman Bharat: WHO chief Tedros Ghebreyesus

Decline in weekly average claims

The Narendra Modi government’s flagship health scheme PM-JAY provides an annual health cover of Rs 5 lakh per family to 10 crore poor and vulnerable families (total 50 crore beneficiaries) for secondary and tertiary care hospitalisation.

The NHA’s analysis covers 22 weeks of data, from 1 January to 2 June 2020. The nationwide lockdown started on 25 March, and continued till 1 June, with different levels of relaxations.

“PM-JAY is in the early stages of offering coverage of Covid-19 treatment to beneficiaries in need. While confirmed cases reimbursed by PM-JAY are still few, it is useful to review claim volumes for packages that might be undiagnosed Covid-19 cases,” the document stated.

Data from the analysis shows a decline in the total weekly average claim volumes for several packages under the insurance scheme, such as pneumonia, respiratory failure, febrile illness, or pyrexia (fever), which could also be symptoms of Covid-19.

“The trend is similar to the overall pattern of PM-JAY utilisation, with a 68 percent decline during the first week of lockdown compared to the previous week,” the document said.

Also read: SC asks private hospitals if they are ready to charge Covid patients at Ayushman Bharat rate

Beneficiaries choosing private hospitals over public

Since the start of the lockdown, beneficiaries seem to have preferred private hospitals over public hospitals for several reasons, including the fear of the greater susceptibility to Covid-19 in public hospitals, the document stated.

“There was a small but perceptible shift in PM-JAY utilisation from public to private hospitals, with several possible explanations for this trend,” it said.

“There was a steeper decline in utilisation of public hospitals (67 per cent from week 11 to 13) than private hospitals (58 per cent), resulting in a shift in the private share of total volumes from 47 per cent before the lockdown to 51 per cent after lockdown.”

The document highlights another trend where the number of “active” hospitals — those submitting at least one claim during a week — fell by almost 50 per cent in both the public and private sectors.

“Activity levels among private hospitals started to recover late in the lockdown but remained low among public hospitals,” it noted.

The NHA’s document went on to list three reasons for the trend.

“First, beneficiaries might be avoiding public hospitals due to a perception that they are becoming ‘Covid hospitals’, since government facilities have been the focus of preparedness efforts for a potentially increasing Covid-19 caseload,” the document read.

The second reason could be that “government hospitals might be too busy with these preparations to carry out tasks related to pre-authorisation and claim submission as required by PM-JAY”, the NHA stated.

And third, it said “the shift towards private hospitals might reflect their case mix — in particular, dialysis care accounts for a large share of PM-JAY claims and is predominantly provided in the private sector”.

Planned surgeries such as cataract operations and joint replacements suffered a decline in demand of over 90 per cent, while the demand for dialysis declined by only 6 per cent, the data showed. There was also a sharp fall in cardiovascular surgeries.

Also read: These are the top states where Ayushman Bharat patients rush for treatment


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