OOPs! Cashless scheme makes patients pay
Ankita Bhatkhande TWEETS @ankitab_MIRROR
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TISS study finds that 63% of beneficiaries of central health scheme had to pay out of their pocket for some expenses
A cashless scheme meant to take care of medical needs of the poor seems to be failing in its endeavour due to poor awareness among patients and sloppiness of some hospitals. A study conducted by Tata Institute of Social Sciences (TISS) has found that over 63 per cent of patients treated under the Rajiv Gandhi Jeevandayi Aarogya Yojana in Mumbai have paid out of pocket (OOP) expenses.This defeats the very purpose of the scheme, which was launched in 2012 in the state, as its primary endeavour is to provide cashless treatment.
A total of 1,489 cases from the city between 2012 and 2014 were surveyed for the study. Sixty-one per cent of the beneficiaries accessed the scheme through private hospitals and 39 per cent from public hospitals.The study was conducted by Priyanta Rent and Soumitra Ghosh under TISS. As many as 971 surgeries and procedures are covered under the scheme. Most beneficiaries of the scheme -32,566 -were from Mum bai and Mumbai suburban districts in 2012-13. Despite being formally enrolled in the RGJAY, over 63 per cent of the beneficiaries still incurred OOP payments for services when admitted to the hospital. More worryingly, it was found that 88 per cent of families living below poverty line paid for diagnostics, medications or consumables. “Our study points to major concerns with regard to the effectiveness of RGJAY in Maharashtra and Mumbai in particular. We found that the households continue to incur OOP payments even while availing services under RGJAY and the OOP spending was more than double in private hospitals than in public hospitals.This clearly suggests the need for empanelling more public hospitals and RGJAY should come up with a mechanism to check the moral hazard behaviour on the part of the private pro viders,“ said Priyanka Rent.
After being asked about the reasons for paying out of their own pockets, a large number of beneficiaries (33 per cent) said that they paid from their own pockets as they were not aware about the expenses covered in the scheme. Other patients said their expenses were not reimbursed by the hospital.
Piyush Singh, CEO of the RGJAY, said: “I have not seen the report yet but we do get many complaints from patients. A large number of cases come from private hospitals as they delay sending all the documents of the patients in time. We take necessary action against such erring hospitals and, if necessary, de-panel them.As far as the awareness is concerned, our staff (Aarogya Mitra) is there in each hospital that is on the panel to assist patients in the process and register their grievances.“
A total of 1,489 cases from the city between 2012 and 2014 were surveyed for the study. Sixty-one per cent of the beneficiaries accessed the scheme through private hospitals and 39 per cent from public hospitals.The study was conducted by Priyanta Rent and Soumitra Ghosh under TISS. As many as 971 surgeries and procedures are covered under the scheme. Most beneficiaries of the scheme -32,566 -were from Mum bai and Mumbai suburban districts in 2012-13. Despite being formally enrolled in the RGJAY, over 63 per cent of the beneficiaries still incurred OOP payments for services when admitted to the hospital. More worryingly, it was found that 88 per cent of families living below poverty line paid for diagnostics, medications or consumables. “Our study points to major concerns with regard to the effectiveness of RGJAY in Maharashtra and Mumbai in particular. We found that the households continue to incur OOP payments even while availing services under RGJAY and the OOP spending was more than double in private hospitals than in public hospitals.This clearly suggests the need for empanelling more public hospitals and RGJAY should come up with a mechanism to check the moral hazard behaviour on the part of the private pro viders,“ said Priyanka Rent.
After being asked about the reasons for paying out of their own pockets, a large number of beneficiaries (33 per cent) said that they paid from their own pockets as they were not aware about the expenses covered in the scheme. Other patients said their expenses were not reimbursed by the hospital.
Piyush Singh, CEO of the RGJAY, said: “I have not seen the report yet but we do get many complaints from patients. A large number of cases come from private hospitals as they delay sending all the documents of the patients in time. We take necessary action against such erring hospitals and, if necessary, de-panel them.As far as the awareness is concerned, our staff (Aarogya Mitra) is there in each hospital that is on the panel to assist patients in the process and register their grievances.“
Source: Mumbai Mirror, 19-112015
