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Table 6 Administrative cost-effectiveness in the two states (September 2018 to March 2019)a

From: The trust and insurance models of healthcare purchasing in the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana in India: early findings from case studies of two states

 

Uttar Pradesh

Jharkhand

Total eligible beneficiary familiesb

11,807,068

5,705,502

Total number of beneficiaries enrolled (% of eligible) (up to March 2019)

2,801,691 (4.7%)

3,093,659 (10.8%)

Total annual premium

-

513,495,180

Utilization rate in 6 months (claims per 1000 eligible beneficiaries) (up to march 2019)

1 per 1000 eligible beneficiaries

3.5 per 1000 eligible beneficiaries

Number of claims generated in 6 months (up to march 2019)

59,468

100,260

Total claim pay-out in 6 months (up to march 2019)

453,843,762 INR

(6.3 million USD)

830,542,833 INR

(11.5 million USD)

Claims ratio (6 months) (up to march 2019)

-

32.4%

Total annual administrative cost b

347,004,095.32 INR

(4.8 million USD)

513,495,180 INR

(7.1 million USD)

Administrative cost estimated for six months (up to march 2019)

173,502,047.7 INR

(2.4 million USD)

256,747,590 INR

(3.6 million USD)

Administrative cost per eligible beneficiary family unit (annual)

29.4 INR

(0.4 USD)

90 INR

(1.2 USD)

Administrative cost per beneficiary enrolled (up to March 2019)

61.9 INR

(0.9 USD)

83 INR

(1.1 USD)

Administrative cost per claim submitted (up to March 2019)

2,917 INR

(40.4 USD)

2,560 INR

(35.4 USD)

  1. aScheme officially commenced on 23rd September, 2018 (nearing the end of the month)
  2. bData provided by the state health agencies of Uttar Pradesh and Jharkhand as of July 2019
  3. INR Indian rupees, USD United States dollars