Hospitals demand cash, poor quality of service; issues surge in Ayushman Bharat grievance system

A review of complaints made by beneficiaries of the Ayushman Bharat scheme in Delhi has revealed that the majority of grievances were related to hospitals demanding payment for treatment, reported TOI citing multiplt reports.

This resulted in unexpected out-of-pocket expenses, even though the scheme was designed to provide cashless hospitalisation and reduce financial burdens.

According to TOI, the 2023 CAG report highlighted that 75 of the 121 healthcare providers removed from the program between 2018 and 2021 were involved in illegal money collection and other fraudulent activities.

State-specific grievances

Meanwhile, a study by the Centre for Health Equity, Law and Policy, along with the Association for Socially Applicable Research, that was accessed by TOI, showed that states like Chhattisgarh, Jharkhand, and Uttarakhand had the most complaints about hospital service quality. On the other hand, Maharashtra, Assam, and Bihar had the most complaints regarding eligibility and registration issues.

Additionally, Uttar Pradesh, Bihar, and Madhya Pradesh had the highest number of complaints about poor behavior from hospital and program staff.

The report explained that most complaints about hospital services were related to hospitals demanding money, while issues around eligibility and registration often stemmed from problems with the issuance of beneficiary cards.

Challenges in data classification

The study, published on the Social Science Research Network, reviewed over 1.1 lakh grievances filed between October 2018 and March 2022 under the AB-PMJAY grievance redress system, said the TOI report.

However, 67% of the grievances were categorised as "other" and could not be analyzed. The remaining 3% were classified as "inquiry" or "feedback."

When the researchers filed an RTI with the National Health Authority to understand what "other" meant, they were told that it was a category selected by the beneficiaries themselves.

Complaints during COVID-19

Although complaints about hospital services made up the largest share of grievances, issues related to registration and eligibility for the Ayushman card were more common during the COVID years.

Of the complaints about hospital services, 74% were about hospitals asking for money.

Other complaints included denial of treatment (15%), hospitals holding onto ABPMJAY cards (6%), lack of medicines and diagnostics (2.2%), and poor treatment quality (2%).

High grievance incidence in Assam

The study also noted that Assam had a significantly higher number of complaints compared to other states.

In Assam, 52% of the grievances were related to eligibility and registration.

The 2023 CAG report pointed out that the average time for approval or rejection of beneficiary registration was 187 days, which could be due to a 70% shortage of staff in the state health agency.