New DelhiWhen the Pradhan Mantri Jan Arogya Yojana (PMJAY) was launched in 2018, it was aimed at saving families from becoming poor as a result of disastrous medical expenditure. However, data from the National Health Authority (NHA), which administers the scheme, shows that the second most claimed procedure under the tertiary health program is the COVID screening test.
NHA data (updated as of August 8, 2022) shows that with 48,18,746 claims, the Covid screening test is second only to hemodialysis (59,67,913 claims) among the top procedures funded under PMJAY. The total funding sanctioned for these tests is Rs 441,41,22,350 (average cost per test is a little over Rs 900).
Both the COVID screening tests – rapid antigen test and RT-PCR – can now be accessed for a few hundred rupees, though officials say they were more expensive when they were first included in the PMJAY. Furthermore, the tests are neither curable nor do they require hospitalization.
Meanwhile, the largest number of claims made under PMJAY are for hemodialysis, even though the government has a dedicated national dialysis program to ease access to treatment since 2016.
ThePrint reached out to NHA CEO RS Sharma over phone and WhatsApp, and the Union Health Ministry over email, but did not receive a response when the report was published. The article will be updated upon receipt of a response.
Why Covid test should be part of PMJAY
PMJAY is the tertiary care arm of the NDA government’s flagship health program Ayushman Bharat, and provides an annual health cover of Rs 5 lakh per eligible family.
in a statement issued On the day of the launch of the scheme in 2018, the Press Information Bureau had said: “The Ayushman Bharat-Pradhan Mantri Jan Arogya Yojana (PMJAY) will provide a cover of up to Rs. 5 lakh per family per year, for secondary and tertiary care hospitalization… The objective of the scheme is to reduce hospitalization costs, meet unmet needs and improve the quality of identified families.
Government sources said that when Covid screening tests were first introduced in the list of packages providing PMJAY coverage, the tests were much more expensive, some running in the thousands.
“When they were offered on the list, the cost of the tests was Rs 4,500. It made sense at the time, as it was not something that the PMJAY target population could afford, and testing needed to be done if necessary to contain the spread of the disease,” said an old-timer from the NHA, who Chosen to remain anonymous.
The old fashioned said: “But the cost of testing has come down drastically. It should have been removed long back, as now it costs up to Rs 150. It is a drain on resources. Continuing this under PMJAY is a scam, especially when the Prime Minister himself has said on several occasions that the scheme is aimed at reducing disastrous health expenditure.
However, a senior NHA official tried to play down the numbers by saying that the numbers were “mostly from 2020-21”, when the pandemic was at its peak.
“When Covid happened, the decision was taken on compassionate grounds to make testing accessible to a larger population. I don’t think too many Covid test claims were made in the last one year or so. We do not fund anything other than secondary and tertiary care,” the official said.
Programmatic overlap?
The procedure for which most of the claims have been made under PMJAY is hemodialysis. This despite the fact that since 2016 the Government of India has also been run A national dialysis program to facilitate easy access to the procedure. Hemodialysis is expensive, and once started in the patient, it cannot be stopped.
NHA sources say there are at least 12 national events – including cataract surgery and normal deliveries – which are also covered under PMJAY, but a decision No action was ever taken to exclude him from the PMJAY list, leaving the door open for potential misuse.
“These should have been cut because only then the money allocated for PMJAY can be used for the purpose for which they are. However, there is a strong resistance to change,” said a person previously associated with the scheme.
The senior NHA official quoted above said that the dialysis program under the National Health Mission does not support dialysis in the private sector.
“We have decided to include dialysis as an additional support system for our beneficiaries, many of whom live in rural areas where access to dialysis facilities is limited,” the official said.
(Edited by Polomi Banerjee)