An analysis by the National Health Authority along with external experts reveals hysterectomy trends under PMJAY
Concerns about hysterectomies being used to milk the Pradhan Mantri Jan Arogya Yojana (PMJAY) May resurface following reports of very high usage by some states.
An analysis by the National Health Authority has found that 75% of all hysterectomy claims werw generated by 6 states: Chhattisgarh (21.2%); Uttar Pradesh (18.9%); Jharkhand (12.2%); Gujarat (10.8%); Maharashtra (9.0%); and Karnataka (6.6 %).
While states like Chhattisgarh and Uttar Pradesh have very high usage, the share of the uptake in the private sector has raised red flag.
UP and Chhattisgarh generated 6900 of the total 17236 hysterectomy claims under PMJAY since its launch. In Chhattisgarh 94.5% of these claims were in private hospitals.
“Findings from Gujarat indicated that hysterectomy was the leading claim in a community-based health insurance scheme, at a mean age of 36 years. Reports from Chhattisgarh, Rajasthan and Bihar highlighted medically unindicated use of the procedure, leading to additional checks on hysterectomy claims…”
In Uttar Pradesh 86.3% procedures happened in the private – NFHS-4 data show 77% hysterectomies in the state happen in private. In Karnataka and Maharashtra though most of the hysterectomies under PMJAY have happened in the public sector
PMJAY is the tertiery care arm of Ayushman Bharat. Hysterectomy refers to the the surgical removal of the uterus. There have been intermittent allegations about patients in the private sector, especially those with health insurance being forced to undergo the procedure without any medical indications for financial considerations. That is why it is often referred to as a “moral hazard” procedure.
The analysis “Patterns of utilization for Hysterectomy: An analysis of early trends from Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (PM-JAY)” has been done by Sukhvinder Kaur, a consultant to the National Health Authority that is responsible for the implementation of PMJAY, Dr. Nishant Jain, a health economist based in Delhi and an advisor to the NHA and Dr. Sapna Desai is an Associate with Population Council of India.
Elaborating on why hysterectomies are an issue, the report writes: “Specific to health insurance, findings from Gujarat indicated that hysterectomy was the leading claim in a community-based health insurance scheme, at a mean age of 36 years. Facility-based media and fact-finding reports from Chhattisgarh, Rajasthan and Bihar highlighted medically unindicated use of the procedure, leading to additional checks on hysterectomy claims submitted under the Rashtriya Swasthya Bima Yojana.”
