Facilitators and Barriers for Pradhan Mantri Jan Arogya Yojana Empanelment by Private Hospitals in Kerala: A Qualitative Analysis

Midhun Rajiv, Leyanna Susan George, Carmel Regeela Mainu, . Arun Raj, M S Aravind

Abstract


Background: Pradhan Mantri Jan Arogya Yojana (PMJAY) is India’s answer to Universal Health Coverage. It aims to reduce catastrophic healthcare expenses and thereby prevent above poverty line families from slipping into the Below Poverty Line category. For its successful implementation, it is crucial that private hospitals be empanelled in the program since majority of the population utilizes the services of private hospitals when compared to the government services. Therefore, the objective of the study is to qualitatively analyze the facilitators and barriers faced by the private health care providers for empanelling in the PMJAY scheme in Ernakulam district. Methodology: A qualitative study using grounded theory approach was conducted. A total of 13 in-depth interviews of private hospital administrators, Comprehensive Health Insurance Agency of Kerala (CHIAK) officials and private insurance company representative were carried. The data were transcribed, manually coded, and thematically analyzed and data triangulation was carried out to draw conclusions. Results: The major facilitators identified for private hospital empanelment in the scheme were social commitment and increase in patient flow. However, the barriers were found to be more than the facilitators and they were insufficient claim rates, compromise on quality of care due to vast patient load, lack of initiative from the side of the authorities for empaneling the private sector, documentation issues, and previous negative experiences shared by previously/currently empanelled hospitals. Conclusion: For PMJAY to be successful, it is crucial that the private hospitals are enrolled in the program. Therefore, appropriate measures need to be taken to overcome the above said barriers and more thrust to be made on the facilitators. The CHIAK officials need to take a more proactive role by engaging in dialogue with the private hospital association and insurance companies for ensuring the success of the PMJAY scheme.

Key words: Pradhan Mantri Jan Arogya Yojana, Private hospitals, Universal health coverage


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