THE nearly 10 weeks of the lockdown saw a “significant” decline in utilisation of the Pradhan Mantri-Jan Arogya Yojana (PM-JAY) by beneficiaries, with average weekly claims falling 51% compared to the months leading up to it, official data shows.
An analysis of data published by PM-JAY for the lockdown period (March 25 to June 2), against the 12 weeks before it (January 1 to March 24), reveals that the decline included critical procedures. At the same time, few PM-JAY beneficiaries availed of the Covid-19 packages announced in April and May compared to the overall caseload in the country, according to the National Health Authority (NHA) that monitors the government’s flagship Ayushman Bharat scheme.
Overall, there was a 57% decline in surgical procedures — from 62,630 claims per week on an average pre-lockdown to 27,167 during the lockdown. Medical cases recorded a 46% fall — 65,341 average claims per week before the lockdown to 35,108.
In terms of average weekly claims, PM-JAY witnessed an 80% decline in planned care and 56% in unplanned care between March 25 and June 2.
The analysis, authored by Owen Smith, Parul Naib, Pulkit K Sehgal and Sheena Chhabra, also showed a “slight” shift from the public to the private sector in the lockdown period, perhaps because government hospitals are bearing the brunt of the coronavirus burden.
The period also saw a decline (by 68%) in the use of respiratory packages such as those for pneumonia, febrile illness or pyrexia. Since these symptoms correlate with Covid-19, the authors said this shows there was no corresponding surge despite the pandemic, at least on the national level.
“The future course of the pandemic in India remains highly uncertain, but during the lockdown period analyzed here, there is little evidence of a surge in Covid-19 caseloads at least on a national level. Therefore it is more likely the threat of Covid-19, not the actuality, that is driving the trends,” stated the authors of the analysis, which was published on June 18.
As of June 10, a total of nearly 8,500 tests and approximately 6,000 treatment packages had been availed of by PM-JAY beneficiaries suspected of or confirmed to have coronavirus, the NHA told The Indian Express. There was a huge jump between the figures for April (826 tests, 853 treatment packages) and May (4,057 tests and 2,426 treatment packages).
As of June 10, India had 1,33,632 active Covid-19 cases.
The sharpest decline was seen in non-urgent elective procedures such as cataract, and knee and hip replacements. From 4,073 average claims per week for cataract, the number fell to a dismal 50 in the first week of the lockdown, before rebounding to an average of 687 in the last three weeks. In case of knee and hip replacements, corresponding numbers fell from 339 to 12 in the first week of the lockdown, before rising to an average of 165 towards the end.
The high-cost cardiovascular surgeries witnessed a nearly 80% drop in the first week of the lockdown. A week before the lockdown, there were 2,269 claims, which dropped to an average of 768 in the first three weeks of the lockdown. In the last three weeks, the average weekly numbers rose to 1,440.
Among the planned and unavoidable emergency procedures that could be life-saving, one treatment that didn’t see a major decline was kidney dialysis – seeing an average drop of 6%. Most of this decline was accounted for by private hospitals in Maharashtra (the state at the heart of India’s Covid crisis), which saw a massive 84% fall in dialysis under PM-JAY. Similar facilities in Andhra Pradesh saw a fall of nearly 40%.
Consequently, dialysis accounted for 51% of all claims under PM-JAY during the lockdown, compared to its usual 20% share.
Cancer care procedures under PM-JAY fell 64% across the country, while even unavoidable procedures like heart stents, bypass, child deliveries and other medical treatments declined 56% on average. The June 18 report showed that of these, “relatively common but higher-cost” heart procedures like stents and bypass dropped around 78% initially but then picked up.
Again, the steepest decline in oncology care was seen in Maharashtra, followed by Tamil Nadu (which also has a high coronavirus tally).
Normal deliveries using PM-JAY across the country dropped around 28%, and Caesarean by 23% — an overall fall of 26%. Bihar’s public hospitals and Chhattisgarh’s private hospitals accounted for the largest drop in normal deliveries — approximately 84% and 95% respectively.