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Despite state-run mediclaim, 60pc forced to pay cash: TISS

Three-fifth of the beneficiaries of the Maharashtra-sponsored Rajiv Gandhi Jeevandayee Aarogya Yojana, which offers cash-less treatment in the city, have been forced to make out-of-pocket payments during hospitalisation, reveals a study.

In spite of the fact that the state had paid the premium for 2.19 crore households in Mumbai, which is 85 per cent of the city’s population in 2014-15, as many as 63 per cent of the beneficiaries had to make out-of-pocket payments for various services at hospitals, says the study by Tata Institute of Social Sciences.

The study has also found that 88.23 per cent of the beneficiaries from BPL families of the city reported paying for diagnostics, medications, or consumables.

The out-of-pocket expenditure on diagnostics and medicines was quite substantial in absolute terms as well as a proportion of the total payments stood at 39.2 per cent and 38.7 per cent, respectively, the white paper prepared by two professors at the Tata Institute of Social Sciences–Priyanka Rent and Soumitra Ghosh–says.

Around 61 per cent of the beneficiaries in the city accessed services from private hospitals and 39 per cent from public hospitals.

At private hospitals, of those who availed the services, 63 per cent were orange ration cardholders (non-BPL families) and only 37 per cent were yellow ration cardholders (BPL families), it said, adding “a reverse trend in public hospital was observed wherein 53 per cent of the beneficiaries were yellow ration card holders and 47 per cent were orange ration card holders.

“For most BPL families, the cost incurred was high and resulted in further worsening of their financial conditions which was caused by factors like transport, food, travel and loss of daily wages, says the study.

According to the findings, most patients resorted to paying from their pockets due to various factors like lack of time to do paperwork, unawareness of the scheme, lack of cooperation from hospital staff or the procedure not being covered under the scheme.

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