A recent study of complaints made by users of the Ayushman Bharat scheme reveals that the top issue reported was hospitals demanding extra money for treatment. This was surprising, as the program was designed to ensure cashless hospitalization and reduce out-of-pocket expenses for patients.
According to a 2023 report from the Comptroller and Auditor General (CAG), 75 out of the 121 healthcare facilities removed from the program between 2018 and 2021 were found to be involved in illegal practices, including charging patients improperly.
The research, conducted by the Centre for Health Equity, Law, and Policy, along with the Association for Socially Applicable Research, highlighted that Chhattisgarh, Jharkhand, and Uttarakhand had the highest number of complaints related to hospital service quality. In contrast, Maharashtra, Assam, and Bihar faced the most issues with eligibility and registration. Furthermore, Uttar Pradesh, Bihar, and Madhya Pradesh reported a significant number of grievances regarding the behavior of hospital staff and the quality of services provided.
The study found that a large portion of the grievances about hospital service quality stemmed from instances where facilities sought payment for treatment. Complaints regarding eligibility and registration mainly revolved around difficulties in obtaining beneficiary cards. The analysis reviewed about 110,000 grievances filed under the Ayushman Bharat Pragati-Marg Samadhan Yojana (AB-PMJAY) system from October 2018 to March 2022. However, 67% of these complaints were classified as ‘other’ and could not be directly analyzed, as well as 3% categorized as ‘inquiry’ or ‘feedback’. According to Shefali Malhotra, one of the report’s authors, the National Health Authority indicated that the ‘other’ category was selected by the beneficiaries themselves.
While issues around hospital service quality were prevalent, complaints about registration and eligibility for the Ayushman card rose sharply during the COVID pandemic. Among the complaints about hospital quality, 74% related to financial demands by hospitals. Other complaints included denied treatment (15%), hospitals retaining AB-PMJAY cards (6%), lack of medicines and diagnostics (2.2%), and substandard treatment (2%).
The study indicated that Assam had a notably higher rate of grievances compared to other states participating in the AB-PMJAY program, with around 52% of complaints focusing on registration and eligibility. The 2023 CAG report pointed out that delays in processing beneficiary registrations averaged 187 days, exacerbated by a reported manpower shortage of 70% within the state’s health agency.
