Evaluation of Pradhan Mantri Jan Arogya Yojana (PM-JAY) Utilization in a teaching hospital of Kalaburagi City, Karnataka

Abstract

Introduction : Ayushman Bharat PM-JAY is the largest health assurance scheme in the world which aims at providing ahealth cover of Rs.5 lakhs per family per year for secondary and tertiary care hospitalization to over 10.74 crores poor andvulnerable families. A timely assessment at various hospitals will help to evaluate the impact of this public health policy.Aim : 1. To assess the utilization of Pradhan Mantri Jan Arogya Yojana (PM-JAY) insurance scheme in Basaveshwarteaching and General hospital Kalaburagi city, Karnataka.2. To assess the reasons for rejection of certain claims.Settings and design: This is an observational study conducted at Basaveshwar teaching and general hospital which is a800 bed tertiary care empaneled private hospital attached to M R medical college, Kalaburagi.Methods and material: Duration of study is 10 months (January to October -2021). Data was collected using semistructuredquestionnaire from the designated Arogya Karnataka office in the hospital. After the entry of data, thedescriptive statistics was presented in frequency tables and graph.Results: From January to October -2021, 1791 patients claimed the PM-JAY benefits. April being the highest due to secondwave of Covid-19, 327 patients claimed PM-JAY insurance. Few claims were rejected for various reasons. NCD burdenwas seen during the study. Conclusion: Creating awareness among the needy population is necessary, modification inthe hospital infrastructure claim processing also plays a key role.