Study: Rs 54K expenses per hospitalisation in pvt facilities under PMJAY, Pg12

Key Highlights:

• A NITI Aayog study reveals that PMJAY patients in private hospitals incur an average of Rs 53,965 in out-of-pocket expenses (OOPE) per hospitalization.
• The study, by IQVIA Consulting, surveyed 2,283 households across 13 states/UTs, finding that 65% had health insurance, mostly government-sponsored (PMJAY).
• 65% of PMJAY beneficiaries paid for medicine, transport, and diagnostics, while 33% incurred no OOPE during hospitalization.
• Uninsured patients in private facilities face Rs 74,847 OOPE, significantly higher than the Rs 11,146 in public facilities.

Detailed Insights:

• The study's findings are crucial for the government's appraisal of schemes before the 16th Finance Commission period starting April 1, 2026.
• While PMJAY aims to reduce financial burden, beneficiaries still face OOPE for medicines and diagnostics, with transport costs not covered.
• PMJAY patients, on average, spend Rs 3,294 less than uninsured individuals, but private hospital OOPE is more than double that of public hospitals.
• The Ayushman Bharat scheme's PMJAY, launched on September 23, 2018, with a Rs 40,112 crore outlay, aims to cover 12 crore families with Rs 5 lakh health coverage per family per year.
• In September 2024, PMJAY expanded to cover all senior citizens aged 70 and above, irrespective of socio-economic status, offering cashless services for 1,961 procedures.

Key Concepts Involved:

• PMJAY (Pradhan Mantri Jan Arogya Yojana): A health insurance scheme providing financial protection to poor families for secondary and tertiary care hospitalization.
• Out-of-Pocket Expenditure (OOPE): Expenses incurred by individuals for healthcare services that are not reimbursed by insurance or government programs.
• Ayushman Bharat: A national health mission aiming to achieve universal health coverage by improving access to affordable and quality healthcare services.