New Delhi: Admissions in hospitals for child-deliveries and cancer treatment under the world’s largest health insurance scheme, Ayushman Bharat, reduced significantly during the 10 weeks of the lockdown, and this trend is “worrying”, which requires “close monitoring”, according to an analysis conducted by the central government.
While the oncology claims fell by 64 per cent across India, child-deliveries fell by 26 per cent during the lockdown, showed the analysis conducted by the scheme’s implementing agency, the National Health Authority (NHA).
The 11-page analysis, titled ‘PM-JAY Under Lockdown: Evidence on Utilisation Trends’, said “of particular concern are significant declines in admissions for child delivery and oncology”.
“The trend is worrying considering the importance of oncology care for cancer patients…,” it said, adding that “another area where the trend may raise some concerns is child-delivery”.
The document, accessed by ThePrint, further said “in any event, this trend merits close monitoring”.
The use of the scheme, formally known as Pradhan Mantri Jan Arogya Yojana (PM-JAY), fell to half during the 10-week lockdown period, according to the report.
Among all the procedures granted under the scheme, planned surgeries such as cataract operations and joint replacements suffered a decline of over 90 per cent, said the report.
The NHA’s analysis covers the data of 22 weeks, beginning from 1 January to 2 June. The lockdown started on 25 March.
The Ayushman Bharat scheme provides an annual health cover of Rs 5 lakh each to 10 crore poor and vulnerable families (total 50 crore beneficiaries) for secondary and tertiary care hospitalisation. The beneficiaries are the bottom 40 per cent of the country’s population.
Fall in institutional childbirth
The fall in childbirth claims “applied almost equally to both normal deliveries and cesarean sections, and was also quite consistent across both public and private hospitals,” the report said.
For instance, during pre-lockdown, the average claims under the scheme per week for normal delivery in public hospitals stood at 3,773, which fell to 2,680 during the lockdown — a fall of 28 per cent. In case of private hospitals, the average claims fell from 472 in pre-lockdown to 389 during lockdown.
Similarly, for C-section, the average weekly claims in public hospitals stood at 3,045 during pre-lockdown, which dipped to 2,322 during the lockdown — a fall of 23 per cent. In case of private hospitals, the average weekly claims fell from 783 in pre-lockdown to 620 during lockdown.
For normal deliveries, the steepest decline was seen in Chhattisgarh (from 99 claims to 5 claims) and Bihar (from 662 claims to 106 claims).
“For C-sections, the state with the steepest decline by far was Madhya Pradesh,” the report said. It, however, didn’t mention the figures for Madhya Pradesh.
What does the fall in institutional child birth mean?
According to the report, the scheme reimburses a small share of total deliveries in India, “as most states have maintained other financing modalities — both supply-side and demand-side — for child deliveries”.
“It is not possible to confirm whether these trends imply a large increase in the number of home deliveries,” the report said, while subsequently adding that “it is certainly plausible due to transport shutdowns”.
It also discussed the possibility of the diminished role of Accredited Social Health Activists (ASHA) due to the lockdown, who otherwise play an important role in ensuring that women deliver at a healthcare institution.
The analysis gave “a more benign explanation” behind the dip, saying it could be that “deliveries are still happening at government hospitals, but administrators have significantly reduced their efforts to submit pre-authorisation requests and claim forms as required under PM-JAY”.
Further, it said that “Ayushman Mitras — hospital staff charged with patient support and PM-JAY implementation — and/or data-entry operators were not able to reach the hospital under lockdown conditions”.
Dip in oncology claims
The government data noted a 64 per cent decline in oncology volumes across India during the lockdown and it was concentrated in a few states.
In the public sector, which plays a smaller role in oncology care under PM-JAY, there was a 90 per cent decline in claims — 907 claims in pre-lockdown to 90 claims during lockdown — in Maharashtra, the state with one of the highest caseloads.
In the private sector, there was a decline in oncology claims from 2,884 in pre-lockdown to 451 claims during the lockdown, in Maharashtra.
Similar trend was seen in Tamil Nadu, Madhya Pradesh and Andhra Pradesh.
“There is some evidence suggesting that ongoing chemotherapy cycles were completed for some patients, but not for others, while new patients were not started,” according to the report.
The report also said the “trend is worrying” and “even more so if a similar pattern emerges in other states that are currently at an earlier stage of the pandemic”.