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Health scheme beneficiaries pay from own pockets -Mihika Basu
-The Indian Express

TISS report maps pitfalls in Rajiv Gandhi Jeevandayee Arogya Yojana

Mumbai: OVER three-fifths or 63 per cent beneficiaries of the state government’s Rajiv Gandhi Jeevandayee Arogya Yojana (RGJAY) made out-of-pocket (OOP) payments for services after admission to hospitals, and a significantly higher proportion of patients from Below Poverty Line (BPL) families (88.23 per cent) reported paying for diagnostics, medications, or consumables, according to a report by the Tata Institute of Social Sciences (TISS).

Under RGJAY, launched by the Maharashtra Government in 2012, BPL and Marginally Above Poverty Line (MAPL) families, with an annual income upto Rs 100,000, are entitled to tertiary care from accredited institutions. According to the study, what is further shocking is that almost half of the RGJAY beneficiaries are from non-eligible category. Further, 15 per cent experienced “catastrophic expenditure” from their own pocket and it was 30 per cent if indirect expenditure is accounted for.

“The study is an attempt to assess the extent to which RGJAY protects families from expenditure while availing tertiary care from RGJAY accredited facilities…Our study found that about a third of the beneficiaries experienced financial catastrophe if indirect expenditure is taken into consideration. This implies that for the poor, ill-health deepened poverty,” says the research paper published in ‘SAGE Open’, an open access journal.

Although the cashless feature of RGJAY sounds attractive, estimates suggest that over three-fifths of the beneficiaries incurred a median expenditure of Rs 3,000 and a mean expenditure of Rs 6,914.

Both primary and secondary data were utilised for the study. Mumbai and Mumbai Suburban district were selected for the study as this district experienced the highest utilisation of RGJAY services.

In total, 51.3 per cent of the families reported a family income of up to Rs 100,000 per annum. Most importantly, results indicate that almost half the households (48.7 per cent) reported a family income higher than Rs 100,000 per annum, but received benefits as they had a yellow or orange ration card.

“Our study points to major concerns with regard to effectiveness of RGJAY in Maharashtra, not only in reaching out to needy, but also providing financial risk protection to insured households. The list provided by the department of food supplies for identification of yellow and orange card holders excluded almost 49 per cent of the ‘real’ eligible households, depriving them of benefits of RGJAY. If the programme is continued in Maharashtra, it should adopt the universal approach, as it would be more effective and includes all needy households,” said study co-author Prof Soumitra Ghosh.

In the sample, 61 per cent of beneficiaries accessed services from private hospitals and 39 per cent from public hospitals. The mean OOP spending in private hospitals was more than twice than at public hospitals. An analysis of public and private hospitals found reasons. “33 per cent cited lack of information as reason for paying for services in public hospitals, followed by unavailability of time to complete all necessary paperwork to avail of the services (19 per cent). In these circumstances, patients hardly have any option other than availing diagnostic facilities and medications from outside (private facilities and chemists’ shops) or paying for services instead of waiting for completing formalities. The next reason was the procedure, or comorbidity was not covered under RGJAY and patients had been asked to pay for services (15 per cent),” says the report.

In private hospitals, predominant reasons cited for paying for services in private hospitals (30 per cent) were procedures not covered under RGJAY, and lack of knowledge (18 per cent). The other reasons were paying for food, noncooperation from hospital staff and “lack of time to complete the necessary paperwork”.

“We found that households continue to incur OOP payments even while availing services under RGJAY and OOP spending was more than double in private hospitals than public hospitals. This clearly suggests the need for empanelling more public hospitals and RGJAYS coming up with a mechanism to check the behaviour of private health providers,” said study co-author Priyanka Rent.