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Evaluation of Pradhan Mantri Jan Arogya Yojana (PM-JAY) Utilization in a teaching hospital of Kalaburagi City, Karnataka

Introduction: Ayushman Bharat PM-JAY is the largest health assurance scheme in the world which aims at providing a health cover of Rs.5 lakhs per family per year for secondary and tertiary care hospitalization to over 10.74 crores poor and vulnerable families. A timely assessment at various hospitals will help to evaluate the impact of this public health policy. Aim(s): 1. To assess the utilization of Pradhan Mantri Jan Arogya Yojana (PM-JAY) insurance scheme in Basaveshwar teaching and General hospital Kalaburagi city, Karnataka.2. To assess the reasons for rejection of certain claims. Settings and design: This is an observational study conducted at Basaveshwar teaching and general hospital which is a 800 bed tertiary care empaneled private hospital attached to M R medical college, Kalaburagi. Methods and material: Duration of study is 10 months (January to October-2021). Data was collected using semi-structured questionnaire from the designated Arogya Karnataka office in the hospital. After the entry of data, the descriptive statistics was presented in frequency tables and graph. Result(s): From January to October-2021, 1791 patients claimed the PM-JAY benefits. April being the highest due to second wave of Covid-19, 327 patients claimed PM-JAY insurance. Few claims were rejected for various reasons. NCD burden was seen during the study. Conclusion(s): Creating awareness among the needy population is necessary, modification in the hospital infrastructure claim processing also plays a key role. Copyright © 2022, Institute of Medico-legal Publication. All rights reserved.