Evaluating Claims Under Ayushman Bharat Pradhan Mantri-Jan Arogya Yojna at a Government Hospital, Uttar Pradesh, India

Ayushman Bharat (AB) is an attempt to move from a sectoral and segmented approach of health service delivery to a comprehensive, need-based health care service. It incorporates a continuum of care strategy, which includes two interconnected components: Health and Wellness Centres (HWCs) and the Pradhan Mantri Jan Arogya Yojana (PMJAY). The research was a descriptive cross-sectional study carried out over 6 months at a government hospital in Uttar Pradesh, which offers tertiary care services. The data on pending claims under AB PM-JAY for 2 consecutive years were obtained and grouped into three different categories based on the number of documents required for claim approval. 10.56% of the total claims were pending on the date of study. Male beneficiaries were more than female. In 2019, most of the pending claims were from the medicine speciality, while in 2020 they were from the radiotherapy department, followed by medicine. This study helped to identify any bottlenecks or inefficiencies that may be causing delays in claim settlement. By addressing these issues, the study can contribute to reducing the financial burden on hospitals and facilitate the smooth functioning of government-funded health schemes in the context of a tertiary care government hospital.