NEW DELHI: Under the Pradhan Mantri Jan Aarogya Yojana (PMJAY), the Centre’s flagship healthcare scheme which promises to cover hospital expenses of up to Rs 5 lakh for nearly 50 crore Indians, the average claim size is just over Rs 13,000, thereby implying that majority of the treatments being availed are low-cost procedures.
The Modi government rolled out the scheme in September last year with an aim to cover over 10 crore families, classified as poor and vulnerable.
The scheme promised to reduce their hospital expenses by taking care of their tertiary and secondary care costs.
However, data accessed by this newspaper shows that till March 14, the average claim size under the programme is only Rs 13,018, a meagre 2.6% of the maximum coverage limit.
But officials in the National Health Authority (NHA), which has been constituted to implement the scheme, insisted that the “top five procedures” being carried out in the country under the scheme are surgeries related to oral and breast cancer, kidney stone removal, compound fractures and coronary artery bypass grafting.
The agency, however, did not share the exact number of beneficiaries treated under these specific packages.
“The average claim size is low, but it is not because beneficiaries are not availing high-end procedures. It is because the average cost of hospitalisation in India is low,” Dinesh Arora, deputy CEO, NHA, said.
“As per the 2014 National Sample Survey data, the average cost of hospitalisation is only about Rs 9,000. Considering that, we seem to be doing much better,” Arora said.
“The fact is that the government is implementing this scheme through public hospitals and small private hospitals, mostly nursing homes, which are largely not even capable of offering specialised tertiary care,” Girdhar J Gyani, director-general, Association of Private Healthcare Providers of India, said.
A health policy expert with the World Health Organisation, said, “Through the scheme, the government has created the demand but there is a big gap on the supply side and people afflicted with serious ailments might not be able to avail the desired benefits due to the lack of tertiary care hospitals and awareness.”