There has been a significant decline in the claims made under the Ayush Bharat- Pradhan Mantri Jan Arogya Yojana (PMJAY) during the lockdown period in India, a report released by the National Health Authority has showed. According to the report titled “PMJAY Under Lockdown: Evidence on Utilisation Trends PMJAY”, there was a steep decline of 64% (as compared to two weeks earlier) in the claims made under the health scheme in the first week since the lockdown was announced. The report confirms the concerns about reduced access to healthcare due to the sudden imposition of the nationwide lockdown to contain the COVID-19 pandemic.
The report also stated that in the 10-week period of the lockdown beginning March 25- June 1, there was 51% decline in the average weekly claims as compared to the average claims in the previous 12-week period. This period also witnessed a fall in the share of claim volumes attributed to women, from 48% before lockdown to 45% post lockdown.
In terms of share of utilisation in private and public hospitals, there was sharper decline in utilisation of public hospitals (67% percent from week 11 to 13) than private hospitals (58%), resulting in a shift in the private share of total volumes from 47% before the lockdown to 51% after lockdown, the report stated.
There were wide variations in the decline of claim volumes across states. While Assam, Maharashtra and Bihar recorded the highest declines at over 75%, states like Kerala, Uttarakhand and Punjab showed lesser decline of 25% or lower.
Critical care like cancer treatment and essential services like institutional deliveries were worst hit by the lockdown. While claims for cancer treatment registered a steep 64% fall, claims for childbirth services (including Caesarian sections and normal deliveries) and neo-natal care fell by 26% and 24%, respectively.
The decline in cancer treatment was higher in the public sector particularly in states like Maharashtra (90%) and Tamil Nadu (65%) as compared to the private sector. The report also noted that chemotherapy cycles were completed for some patients but not for others, while new patients were not started.
The report also noted a decline in claim volumes by women, from 48% in the pre-lockdown period to 45%. Earlier in April, another report released by NHA had noted that according to the National Sample Survey, there are “wide state-wise gender gaps for average expenditure on medicine, ranging from 1.9% to 67% for treatment per hospitalisation case”. It added that under the PM-JAY scheme, the gender gap range for claims paid for hospitalisation ranges from 2.9% to 30%.
While average claims for medical services witnessed a 46% fall from 65,300 in the weeks prior to the lockdown to 35,100 during the lockdown, for surgical services the drop in claims was higher at 57% from 62,600 to 27,100.
According to the report, the fall in value of claims was higher at 76% compared to the fall in volume (64%). This is due to a larger decline in higher cost packages including surgeries. The total decline in outlays over ten weeks compared to a hypothetical no-lockdown scenario (that is, a continuation of the pre-pandemic status quo) amounted to over Rs 1,000 crore, or 15% of the Union Governments PM-JAY budget allocation (excluding state shares).
As far as non-urgent elective procedure such as cataract surgery and hip and knee replacements are concerned, claim volumes decline by a whopping 99% and 97%, respectively in the first week of the lockdown . In the later weeks of lockdown, there were signs of a gradual recovery of both, especially joint replacement.
“What this report shows is a collapse of essential health services at many places,” said T. Sundararaman, former director of the National Health Systems Resource Centre, a unit of the Union health ministry, was quoted by The Telegraph as saying.
The Jan Swasthya Abhiyam or the People’s Health Movement had previously raised concerns about the impact of the lockdown on healthcare services and questioned the rationale for the Union health ministry’s advisories discouraging elective surgeries and outpatient consultations.
Commenting on the shift to the private sector, Sundararaman told The Telegraph, “This shift to the private sector likely occurred because the public hospitals were repurposed for the coronavirus treatment.”
The NHA report stated that private hospitals may have reduced their services because of a fear of infection among their healthcare workers or a fear among the owners about their business outlook being jeopardised if they were thought to be treating COVID-19 patients.
Also read: Health Experts Slam Private Sector Response to Pandemic, Urge Centre to Take Control