Ayushman Bharat claims slump as much as 78% in May during lockdown

Pre-authorisation claims under the government’s flagship Ayushman Bharat insurance scheme were down by as much as 78% in May as compared to the pre-lockdown month of February, indicating that fewer people enrolled under the scheme were able to visit hospitals for treatment.

The worst hit segment was respiratory disease where the number of claims were just 7,468 as compared to over 34,000 in February, while that for cancer, cardiology and gynaecology procedures, the decline was 38-58%, data from the National Health Authority, which runs the Pradhan Mantri Jan Arogya Yojana (PMJAY) insurance scheme, showed.

The amount claimed under the pre-authorisation also showed a similar trend, down by 38-72% from February for the four services.

In May, except for claims for respiratory diseases, the situation for the other three segments was slightly better than April, when restrictions under the lockdown were more severe across the country. In April, the total number of claims were down 46-74% from February.

However, there was still a decline of 44% in oncology treatments in May, with only 23,669 claims being made by cancer patients enrolled in the scheme, while for cardiology patients, the number of claims was just 6,055 as against 14,534 claims in February, a decline of 58%.

For respiratory disease treatments, however, claims were down 77% even in April, and the situation continued to remain so in May as well.

Claims for gynaecology and obstetrics procedures were down 38% to 34,958 in May as fewer women opted for institutional deliveries and even treatments of critical health issues were postponed.

“Institutional deliveries and caesarean procedures had gone down by around 40-50% (year-on-year) in March. Women are not being able to get healthcare procedures because of the lockdown, especially in smaller cities and rural areas, because doctors and ASHA workers have been put on the covid. It seems that by focusing on covid, we might lose lives to other health problems,” Subhasri Balakrishnan, a gynaecologist with CommonHealth, told Mint.

The data seems to signify that patients continued to either avoid hospitals or were unable to get treatments in May despite the government allowing public transport and easing provision of non-covid non-essential healthcare services in May.

“For our Darbhanga facility, use of overall healthcare services were down by around 90% in April and about 75% in May, and from our experience in Gurgaon and from talking to my friends who own hospitals in cities like Delhi, Mumbai, Bengaluru, this seems to be a trend across India,” Paras Healthcare Pvt Ltd managing director Dharminder Nagar told Mint.

Paras Healthcare’s hospital in Darbhanga, Bihar is empanelled under Ayushman Bharat-PMJAY insurance scheme.

Nagar said that a host of factors played a role in the decline in hospital visits by patients. The most important reasons were the fear of the respiratory pandemic among patients and doctors, while shutting down of public transport also played its role.

“Darbhanga town contributes maybe about 25% of the business at the hospital. Majority of the patients actually come from the nearby villages, and most of them use public transport like buses to reach the hospital. In a lockdown, that was absolutely gone,” Nagar said, adding that a similar situation was seen across the country.

Health activists say some of the fault also lies with private hospitals, who refused to admit patients.

“Many private hospitals have stopped providing services to patients and the burden for both Covid and non-Covid healthcare has fallen primarily onto public hospitals,” said Sulakshana Nandi, joint national convenor of Jan Swasthya Abhiyan.

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