[Answered] Analyze the role of incentives in the implementation of PMJAY. How do the current incentive structures impact the behavior of medical personnel and the overall effectiveness of the scheme? Use examples from the article to support your answer.

Introduction: Describe PMJAY.

Body: What role do incentives play in the overall effectiveness of the scheme?

Conclusion: Way forward.

Ayushman Bharat, a flagship scheme of the Government of India, was launched to achieve the vision of Universal Health Coverage (UHC). The second component under Ayushman Bharat is the Pradhan Mantri Jan Arogya Yojana or PM-JAY. It is the largest health assurance scheme in the world which aims at providing a health cover of Rs. 5 lakhs per family per year for secondary and tertiary care hospitalization to over 12 crores of poor and vulnerable families that form the bottom 40% of the Indian population. The households included are based on the deprivation and occupational criteria of Socio-Economic Caste Census 2011 (SECC 2011) for rural and urban areas respectively. PM-JAY is fully funded by the Government and the cost of implementation is shared between the Central and State Governments.

What role do incentives play in the overall effectiveness of the scheme?

  • Staff incentives: It is seen that incentives play a key role in doctors ’ decisions to decide the type of medical package needed for patients. In some cases, financial incentives of private players outweigh the gains for the doctor resulting in poor implementation of the scheme.
  • Lack of active interest of employees: Studies found that there was a lack of active interest in the scheme by the medical team in public facilities. This was on account of providing the required documents within a stipulated time or public personnel did not take interest in follow-up of queries (if any) raised by the state-level agency on the submitted claims.
  • Modest physical infrastructure: With inadequate infrastructure and human resources the medical team of public facility are often overstretched resulting in poor execution of the scheme. For example, Aarogyamitra who has the responsibility to register the patient and his salary is linked to no of cases he registers has little incentive to follow up the claims with the required documentation at subsequent stages and ensure settlement.
  • Lack of services in facilities: The incentives for hospital staff are also linked to the claim settlement which gives additional income to the facility. But lack of services available in these facilities limits the scale of potential revenues that can be generated.

Conclusion:

There is a need to address operational challenges related to the scheme. The additional revenues could be generated by participating in the scheme which can be utilised for infrastructure development. This in turn could raise the potential for the public facility to cater to more health packages & achieve the vision of UHC. There is a need to establish a framework where state government can fulfill their constitutional obligation of taking responsible control over “Health” as a subject listed in the 7 schedules by providing adequate manpower and enforcing accountability to ensure a higher volume of services in public facilities.

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