How Do Discrepancies Affect Ayushman Bharat's Healthcare Goals?

In a recent report released by the Comptroller and Auditor General (CAG) of India, concerning irregularities in the implementation of the Ayushman Bharat – Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) health scheme, significant concerns have been raised about the distribution of health coverage to vulnerable families. The scheme, aimed at providing Rs 5 lakh health coverage to over 10 crore impoverished families, has come under scrutiny due to alleged discrepancies and deficiencies.

Beneficiary Validation and Database Errors

The CAG report, titled "Performance Audit of Ayushman Bharat," highlights various inconsistencies, notably the absence of sufficient validation controls and errors within the beneficiary database. Instances of invalid names, unrealistic dates of birth, duplicate PMJAY IDs, and unrealistic family sizes were observed. The audit, conducted from September 2018 to March 2021, uncovered shortcomings that have potentially allowed ineligible beneficiaries to avail of scheme benefits.

Duplicate and Invalid Registrations

Startling revelations emerged from the report, including the registration of multiple beneficiaries using the same or invalid mobile numbers. The audit identified instances of 7,49,820 beneficiaries linked to a single cellphone number (9999999999), with similar occurrences for other numbers. These discrepancies in mobile number records raise concerns about accurate beneficiary identification and communication.

The audit also highlighted the issue of delayed action in identifying and removing ineligible beneficiaries from the scheme. This lapse has led to ineligible individuals benefiting from the program, thereby resulting in excessive premium payments to insurance companies. Surprisingly, government pensioners were found to be among the beneficiaries, indicating that the eligibility criteria might not have been rigorously enforced.

National Health Authority's Response

The National Health Authority (NHA), in response to the audit findings, acknowledged the shortcomings and pledged to develop a Standard Operating Procedure (SOP) to ensure states adhere to the AB-PMJAY criteria. The proposed SOP aims to facilitate the removal of ineligible beneficiaries from the list of eligible individuals and families.

An additional significant observation from the report is the presence of unrealistic household sizes among registered beneficiaries. The analysis revealed that approximately 43,197 households had family sizes ranging from 11 to 201 members, suggesting a lack of essential validation controls during the beneficiary registration process. This discrepancy also underscores the need for a clear definition of "family" within the scheme guidelines.

The CAG report sheds light on critical irregularities in the implementation of the Ayushman Bharat health scheme, potentially leading to the denial of benefits to eligible beneficiaries, communication challenges, and financial losses. As authorities work towards rectifying these issues, the focus remains on ensuring that the scheme truly serves its intended purpose of providing essential health coverage to vulnerable families across India.