The Pradhan Mantri Jan Aarogya Yojana, launched in September 2018 by Prime Minister Narendra Modi, pledges to pay the hospitalization charges — up to Rs 5 lakh a year per household — incurred by 100 million poor households, which make up an estimated 40 percent of the country’s population. Federal research strengthened the belief that certain private hospitals may have given improper care to cancer patient parts in order to increase the number of claims under the national health insurance program. The study, which analyzed the oncology services provided by the Yojana, found “significant differences” between the statements made by private and public hospitals in empanelled form. The overall results of the private sector for different types of cancer care have always been significantly higher than those of the public sector.
The analysis, commissioned by the National Health Authority implementing the Yojana, covered approximately 188,000 oncology-related claims made during the scheme’s first 10 months and found that 72 percent were from private hospitals. According to the paper, the higher average claim size from private hospitals may result from higher treatment and surgeon fees or “supplier-induced demand,” a term used by health economists to describe treatment services promoted by doctors or health care institutions.
“The average claims from the private sector are higher for the same sets of packages, which raises questions. But someone has to make a detailed patient-level analysis on individual claims to determine whether individual patients received the correct treatment,” said Pramesh Chandra Bhatnagar, a medical doctor and the senior director, programs, at the Voluntary Health Association of India, who had reviewed the paper. Sudhakar Shinde, a Maharashtra-subsumed physician, said the state plan had observed private hospitals claiming radiation oncology on unexpectedly large proportions of patients with cancer. “The packages under radiation oncology have large reimbursements, and this sparked questions as to whether radiation therapy was given to some patients even though they might not have needed it,” Shinde said.
The analysis also found that a skewed distribution of oncology services resulted in “major inequalities” in access to cancer care, with most patients still having to travel long distances in order to receive treatment in top hospitals.
The Yojana signed an agreement of understanding with the National Cancer Grid in May this year to foster, among other things, uniform standards of care for preventing cancer, diagnosis, and treatment.
The report advised that cases be addressed with the National Cancer Grid’s esteemed experts to provide “care appropriately”0