RAS question
According to NITI Aayog, what percentage of PM-JAY beneficiaries incur out-of-pocket expenses despite coverage?
Correct answer: (A) 65%.
According to a NITI Aayog-commissioned evaluation study, 65% of PM-JAY beneficiaries incurred out-of-pocket expenses during hospitalisation despite being covered by the scheme.
Explanation
The NITI Aayog-commissioned evaluation found that PM-JAY coverage did not make every hospitalisation fully cashless. In the survey findings reported by The Indian Express, 35% of those covered under PM-JAY had no out-of-pocket expenditure during hospitalisation, while the remaining 65% still paid for medicines, transport and diagnostic services. That is why 65% is the relevant figure: it captures beneficiaries who were covered by the scheme but still had to spend from their own pocket. The finding also explains the policy concern behind the question. PM-JAY is meant to reduce the financial burden of hospitalisation, but non-covered or incidental costs can still make beneficiaries pay despite formal coverage.
Why the other options are wrong
- (B) 50% is not the figure reported in the NITI Aayog-commissioned study; the reported split is 65% with out-of-pocket expenditure and 35% with no such expenditure.
- (C) 35% refers to PM-JAY beneficiaries who did not incur any out-of-pocket expenditure during hospitalisation, so it is the opposite of what the question asks.
- (D) 80% overstates the reported burden; the cited finding says the remaining 65% of PM-JAY-covered beneficiaries had to pay out of pocket.
Concept
This tests health-sector welfare delivery under Indian Economy, especially the gap between insurance coverage and actual financial protection. RAS often asks such scheme-evaluation facts because they connect flagship welfare programmes with implementation outcomes.