Many patients and the attendants of patients registered under the Ayushman Bharat PMJAY insurance scheme have to run from pillar to post in the hospital.
At the Post Graduate Institute of Medical Education and Research (PGIMER), two young men looked around in a frenzied hurry, dodging the furniture and hand drawn transportation carts, navigating the narrow passage outside the hospital’s pharmacy to reach the ward where their mother was admitted. “We have to purchase medicines for our mother who has acute hyperglycemia. We have been running around the hospital trying to get her medicines under the Ayushman Bharat scheme. Now since the pharmacy has run of some medicines, we will go buy them from a private pharmacist,” said Mohit, the younger of the two men.
Like Mohit and his elder brother, many patients and the attendants of patients registered under the Ayushman Bharat PMJAY insurance scheme have to run from pillar to post in the hospital and outside to procure medicines covered under the insurance packages of the PMJAY scheme. A member of the nursing staff, who looks after patients in the emergency ward, said that most of the patients’ resolve wears out after running around in the hospital to no avail, and they end up buying medicines from private chemists without availing reimbursements.
“First the patient has to get the prescription stamped by a member of the medical staff and approach the pharmacy. If the pharmacy is out of certain medicines, they come back to us later, and then, we have to get another stamp of approval and approach the AMRIT store,” said a nurse, who wishes to remain anonymous. The staff member added that when patients do not get the required medicines at the government-run AMRIT pharmacies inside PGIMER, they approach Kumar Medical Store located in Sector 11, which is the last option for those seeking to procure free medicines under the PMJAY insurance packages.
Even after running around for hours – if not days – in order to timely administer medication to the patient suffering in the wards, attendants are often unable to get claim for some medications. “My relative had to get a few medicines for me and they ultimately ended up buying from private chemists because often there is no time to run around. There is also no way to avail refunds for the medicines we are unable to procure from the authorised pharmacies,” said Ram Raheem, a resident of Himachal Pradesh and an Ayushman Bharat card holder getting treatment at the hospital. “There should be a single window where we can claim our medicines on time, otherwise what is the point of the insurance,” added the patient.
Before getting into the stressful ordeal of procuring medicines under the scheme, beneficiaries and their attendants also have to spend hours registering themselves or their loved ones at an Ayushman Bharat counter. A man from Kurukshetra, whose son is admitted in the emergency ward because of a neuro disease, said that his family has been buying medicines from private chemists, while he has been attempting to register his son under the insurance scheme at PGIMER. “I do not know where the medicines will be available, I have heard that at times they are out of stock, but let’s see maybe I will get a reimbursement,” said the hopeful father.
“Other hospitals in the city also have a single window procedure. This allows to make the patient’s experience smooth, and also decreases the chances of fraud over bills submitted for reclaiming money for medicines under Ayushman Bharat,” said an official source. Hospitals like Government Medical College and Hospital in Sector 32 have authorised only AMRIT stores to provide medicines to Ayushman Bharat beneficiaries. A letter circulated within PGIMER in January 2019 also stated that the faculty should ensure that medicines are procured solely through “Jan Aushadhi/ AMRIT store set up by the government of India with expenditure within the package ceiling prices”.
Spokesperson of the hospital, Dr Ashok Kumar said that efforts are being made by PGIMER’s administration to implement a single window procedure for accessing medication under Ayushman Bharat. “We are cognizant of the inefficiency and loopholes in terms of auditing the bills that are submitted by the various pharmacies. We have a separate space for a new pharmacy and when we relocate we will be able to open an exclusive window for the Ayushman Bharat beneficiaries,” said Kumar.
Apart from inadequate space, hospital’s Medical Superintendent Professor AK Gupta said that PGIMER has been unable to streamline the process of delivering medicines to the Ayushman Bharat beneficiaries due to an acute shortage of pharmacy staff. “We are short of eight staff members at the pharmacy which caters to so many patients, including hospital employees and patients holding poor patient cards. We have approached higher authorities to make sure we are equipped to run our pharmacy efficiently and have also sent letters to the National Health Agency regarding the issue,” said Gupta.