51% decline in avg weekly claims under Ayushman Bharat scheme during COVID-19 lockdown: Report

New Delhi: There was a 51 per cent decline in the average weekly claims under the Ayushman Bharat health insurance scheme during the coronavirus-triggered lockdown, according to an analysis done by a group of researchers.

Also, there was a steeper decline in utilisation of services in public hospitals than private hospitals during the lockdown, from March 25 to June 2, stated the National Health Authority (NHA) publication titled 'PM-JAY Under Lockdown: Evidence on Utilization Trends PM-JAY'.

The NHA is the apex body responsible for the implementation of health insurance scheme -- Ayushman Bharat-Pradhan Mantri Jan Aarogya Yojna (AB PM-JAY).

Among procedures, planned surgeries such as cataract operations and joint replacements suffered a decline of over 90 per cent, while hemodialysis declined by only 6 per cent.

There was also a sharp fall in cardiovascular surgeries.

Of particular concern are a significant decline in admissions for child delivery and oncology, the report stated.

Overall, claims per week on an average for surgical procedures fell down to 27,167 during the lockdown from 62,630 being recorded before the lockdown started, registering 57 per cent decline.

There was a larger decline in utilisation of surgical procedures (57 per cent) than medical cases (46 per cent) .

This is to be expected since surgeries are more commonly planned in advance, whereas medical cases are not, the researchers said.

Another area where the trend in claim volumes raise some concerns is child delivery.

Across PMJAY, there was a 26 per cent decline in child deliveries during the lockdown and this applied almost equally to both normal deliveries and caesarian sections and was also quite consistent across both public and private hospitals, the report stated.

Among demographic groups, women, younger and older populations (under 20 and over 60) reduced their utilisation more than men, young adults or the middle-aged.

According to the report, the weekly nationwide PMJAY claim volume during the first week of the lockdown was 64 per cent lower than just two weeks earlier, the analysis showed.

"The decline in average weekly claim volume was 51 per cent if the 10-week lockdown period (March 25 to June 2) is compared to the 12 weeks that preceded lockdown (January 1 to March 24)," the report said.

"There was a steeper decline in utilisation of public hospitals (67 per cent from week 11 to 13) than private hospitals (58 per cent), resulting in a shift in the private share of total volumes from 47 per cent before the lockdown to 51 per cent after the lockdown," it stated.

This trend, which became even stronger late in the lockdown, may reflect several factors, researchers stated.

First, beneficiaries might be avoiding public hospitals due to a perception that they are becoming 'COVID hospitals', since government facilities have been the focus of preparedness efforts for a potentially increasing COVID-19 caseload.

Secondly, government hospitals might be too busy with these preparations to carry out tasks related to pre-authorisation and claim submission as required by PM-JAY.

Third, the shift towards private hospitals might reflect their case mix -- in particular, hemodialysis care accounts for a large share of PM-JAY claims and is predominantly provided in the private sector, and the decline in claim volumes for these packages was far lower than for other types of care, the report stated.

Also, there was wide variation in claim volume trends across states, with the steepest declines (over 75 per cent) in Assam, Maharashtra and Bihar, while much smaller declines (about 25 per cent or less) were observed in Uttarakhand, Punjab and Kerala.