Study finds beneficiaries under PM-JAY in four southern states have paid from their pocket for COVID-19 treatment

An estimated 3 lakh patients from Tamil Nadu had to fund hospitalisations through personal savings or borrowings, the study revealed

A study on the efficacy of the Pradhan Mantri Jan Arogya Yojana (PM-JAY scheme) in the four southern states of Andhra Pradesh, Karnataka Kerala and Tamil Nadu, has found that a sizeable population covered under the programme bore hospitalisation expenses for COVID-19 treatment from personal funds or borrowings.

As of August 2021, an estimated 85% of the 26 crore population in the four states (over 20 crore) is covered under the scheme. In Tamil Nadu as much as 98% of the population and in Kerala 58% of the eligible population is covered. Also, in the four states around 95 lakh beneficiaries are authorised for hospital admission under the scheme.

While so far 18 lakh people have been hospitalised for COVID-19 treatment around 85% of them (over 10 lakh) have paid for their hospitalisation from personal savings or borrowed money.

Of the 3.16 lakh PM-JAY beneficiaries treated for COVID-19 so far in the States under review, 1.54 lakh were in Andhra Pradesh and 1.62 lakh, in Karnataka.

In Tamil Nadu of the 4 lakh estimated hospitalisation for COVID-19, only 10,377 persons and in Kerala of the 7 lakh estimated hospitalisations only 34,755 were treated for the COVID-19 under the PM-JAY scheme. An estimated 6+ lakh COVID-19 patients in Kerala and 3+ lakh patients in Tamil Nadu had to fund the hospitalisation through personal savings or borrowings.

While 12% of the beneficiaries in AP had availed themselves of hospitalisation benefits under the scheme, in Tamil Nadu only 0.3% had benefited.

In 450 days, as many as 1,12,638 persons had died of the infection. Karnataka recorded the highest number of deaths at 37,797. Andhra Pradesh recorded the lowest at 14,176, which the study attributed to “excellent clinical management strategy.” In Tamil Nadu 35,578 persons have died and in Kerala, 25,087 persons succumbed to the infection.

Two hospitals in urban Bengaluru, namely Victoria and Bowring, had saved a large number of uninsured middle-income COVID-19 patients but public heart hospitals were approximately three times costlier than private for-profit hospitals, the study said.

According to the study, AP’s private hospitals empanelled in the scheme had “offered fair value for the services” and thus achieved least death per million of 168 as compared to Kerala (751); Karnataka (619) and Tamil Nadu (493).

Poor response

In Tamil Nadu there was poor response from private hospitals in treating PM-JAY beneficiaries. The study concluded that the State’s decision to conduct 100% RT-PCR tests for COVID-19 had immensely benefited private labs with 15 of the top 25 empanelled hospitals that received the highest number of authorisation for treatment under the scheme being testing laboratories.

In Karnataka except for Bengaluru urban, other districts appeared to be relatively successful in getting the PM-JAY benefits to the poor.

In Kerala, the scheme had been extensively used to treat over 25 lakh beneficiaries and 16 of the 25 COVID-19 designated hospitals had treated 7.82 lakh beneficiaries. However, only 34,755 were reported as COVID-19 cases, the study found.

The study project, Jeevan Raksha, was technically supported and guided by Public Health Foundation of India (PHFI).

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