Out-of-Pocket Expenditure in Patients admitted to Cardiology Department under ABPMJAY scheme in a Tertiary Care Hospital in Delhi: A Cross-Sectional Study

Introduction: The recent National Health Accounts 2019-20 data reveals that Out-of-Pocket Expenditure (OOPE) as a percent of Total Health Expenditure is more than 47% which is still higher compared to out-of-pocket health spending in other developing nations. Ayushman Bharat-Pradhan Mantri Jan Aarogya Yojana (AB-PMJAY), the world’s largest public-funded social health insurance scheme is a by-product of National Health Policy 2017 recommendations to achieve Universal Health Coverage and reduce OOPE in health. The present study was conducted to know the OOPE among the patients admitted to the Cardiology department under AB-PMJAY scheme in a tertiary care hospital in New Delhi. Methods: A descriptive cross-sectional study was carried out from January 2021 to April 2022 among the patients admitted under the PMJAY scheme in the Cardiology Department of Tertiary Care Hospital in New Delhi. A total of 320 patients were interviewed using a structured questionnaire divided into eight sections. The collected data was tabulated in Microsoft Excel and analyzed. Results: The study investigated out-of-pocket expenditure (OOPE) for patients, finding the scheme covered doctor consultations, bed charges, physiotherapy, implants, and oxygen, but some patients still faced OOPE for diagnostics (15%), medicines (22.5%), blood transfusions (8.75%), and ambulance with an average direct medical expenditure of approximately Rs. 1511 during the hospital stay at the current hospital. Compared to previous hospitalizations, OOPE for diagnostics, medicines, and blood transfusions significantly decreased under PMJAY. Overall, 60.3% of respondents were satisfied with the PMJAY scheme. Conclusion: The PMJAY scheme helped the beneficiaries to reduce the financial burden of health to a great extent. However, few of the beneficiaries continued to make some payments from their pockets for diagnosis, medication, etc. The main reason for this was a lack of knowledge and awareness about the scheme among the beneficiary population.