New Delhi: The Pradhan Mantri Jan Arogya Yojana (PM-JAY), the tertiary care arm of the Narendra Modi government’s flagship health insurance scheme Ayushman Bharat, has been pitching itself as a “boon for migrants” during the Covid-19 lockdown.
However, data from the National Health Authority, the agency that manages the scheme, shows that this target group may not have benefitted much, contrary to the government’s claims.
The portability feature in PM-JAY, which PM Modi has spoken about, allows beneficiaries to go to any empanelled hospital in the country for treatment, regardless of its location or the beneficiary’s place of registration. The feature was designed to help poor patients get treated in premier tertiary care institutions like AIIMS, New Delhi, and the Tata Memorial Cancer Hospital in Mumbai.
During the lockdown, it was presumed that the portability feature would find wider utilisation, as migrants would use it in places different from where they are registered. But that doesn’t seem to have happened — data from the NHA shows that portability claims as a percentage of total claims went down in some top states like Madhya Pradesh, Punjab and Haryana, and rose only slightly in Uttar Pradesh. Bihar was the only anomaly among the top states, where the portability claims increased significantly.
Total hospitalisations under PM-JAY — the world’s largest government funded health insurance programme — have also come down significantly. The NHA has now started a campaign to reach out to migrant workers.
Launched on 23 September 2018, Ayushman Bharat provides an annual health cover of Rs 5 lakh per family to 10.74 crore families.
NHA data shows that Madhya Pradesh tops the list of states with the most number of portability cases, followed by Uttar Pradesh, Bihar, Punjab and Haryana.
During the pre-Covid months of December 2019 and January 2020, 9.1 per cent and 8 per cent of MP’s patients availed of treatment facilities away from their home state. In May and June, the figure came down to 5 per cent.
For Uttar Pradesh, the portability percentages in December and January were 6.4 and 6 respectively, but went up marginally to 7.2 per cent and 6.8 per cent in May and June.
Only Bihar registered a sharp increase in portability — its percentages for December and January were 8.1 and 9 respectively, but for May and June, they rose to 16.8 per cent and 17 per cent respectively.
For Punjab and Haryana, like MP, the numbers went down during the lockdown, as travel restrictions were in effect and many migrants were stuck in their places of work without any means to go back home.
Punjab had 3.5 per cent and 3.4 per cent portability cases respectively in December and January, which went down to 1.4 per cent and 1.6 per cent in May and June. Portability cases in Haryana were 4.7 per cent and 4.8 per cent in December and January, but declined to 3.6 per cent each in May and June.
In each state, the absolute number of cases came down sharply during lockdown.
Travel restrictions changed usage pattern
NHA CEO Indu Bhushan said the data could be a reflection of how the travel restrictions changed health seeking behaviour.
“There are two kinds of portability patients. There are those that actively go out of their home states to seek treatment because good quality facilities are not available there. This group could not move out because of the lockdown,” Bhushan said.
“Then there is a second group that avails services outside the state of origin, because that is where these people are based. Bihar’s portability numbers may have risen because Biharis may have been more in the second group,” he said.
There is also the problem of “distortion” in hospital profiles in the last five months. Many hospitals have become exclusive Covid facilities, while some have even closed down because of lack of non-Covid patients.
“A lot of patients would come to AIIMS Delhi, but services were curtailed there. That reflects on the numbers. TMCH Mumbai did not cut down services, but even there, patients could not reach,” Bhushan added.
Campaign for migrant workers
Now, the NHA has launched a campaign titled ‘Swasthya ki chhaanv, sheher ho ya gaanv’ to reach out to migrants, and educate and empower them to avail free healthcare services under Ayushman Bharat PM-JAY, especially using the portability feature.
Of the total of nearly 1.09 crore admissions until 17 July, 14.61 lakh were portability cases, amounting to a total Rs 2,077.8 crore in claims.