ANSWER
THE MINISTER OF STATE IN THE MINISTRY OF HEALTH AND
FAMILY WELFARE
(DR. BHARATI PRAVIN PAWAR)
a): Yes.
b): A summary of the findings from the survey is at Annexure - I.
c): The state-wise (including Bihar) number of such hospitals in the country, against whom allegations of denial of treatment under AB-PMJAY have been reported by beneficiaries despite being empanelled under the scheme is given at Annexure - II. The district wise number of hospitals in Bihar against whom allegations related to denial of treatment was reported under AB-PMJAY is given at Annexure - III.
d): To ensure that disputes and grievances related to denial of treatment or demanding of money by hospitals, and any other types of grievances involving beneficiaries, healthcare providers and other stakeholders under AB-PMJAY are resolved in an efficient, transparent and time-bound manner, National Health Authority has developed Grievance Redressal Guidelines and put in place a Central Grievance Redressal Management System (CGRMS).
Grievance Redressal under AB-PMJAY has a three-tier system at District, State, and National Level. At each level, there is a dedicated nodal officer viz. District Grievance Nodal Officer (DGNO), State Grievance Nodal Officer (SGNO) and National Grievance Nodal Officer (NGNO). Also, at each level, there is a committee formed viz. District Grievance Redressal Committee (DGRC) at district level, State Grievance Redressal Committee (SGRC) at state level and National Grievance Redressal Committee (NGRC) at national level to address the grievances.
An IT-enabled and web-based grievance redressal system has been developed which enables a person to register a grievance on the portal https://grievance.pmjay.gov.in or https://cgrms.pmjay.gov.in. Also, citizens can lodge grievance through national call centre 14555 or through mail, letter, fax etc., which will be acknowledged, recorded, escalated & resolved as per procedure laid down in grievance redressal guidelines. Any grievance regarding denial of treatment by an empanelled hospital which is registered by beneficiaries at the time of admission and before discharge are considered as SOS grievances and Turn Around Time of 6 working hours has been defined to resolve these types of grievances.
Complaints or grievances received through any medium are immediately assigned to respective Grievance Nodal Officer designated at State and district level for necessary action. The concerned officer will take necessary action to resolve the case either through direct channel or placing it before the committee.
The State & district level authority connect with the concerned hospital against which the grievance has been raised. They also connect with the beneficiary to understand the nature of the grievance. Based on the information collected from the beneficiary and the hospital, the issue is resolved. It is ensured that the treatment is provided to the beneficiary.
Many times, complaints filed by the beneficiary in this regard are found to be incorrect e.g. beneficiaries due to lack of information demand services related to such speciality for which the hospital is not empanelled under the scheme, or grievance is lodged against denial of services against hospitals which are either not empanelled, or have been suspended or de-empanelled. Such grievances are dropped.
Other grievances which are found to be genuine are resolved and it is ensured that beneficiary is provided treatment by the empanelled hospital. However, if the hospital denies providing the treatment as per the established procedure & protocol under Ayushman Bharat-PMJAY, necessary action including suspension and de-empanelment of hospital is undertaken by the respective State Health Agency.
As on 27th July 2021, 2107 grievances related to denial of services have been received from the launch of the scheme, of which 1995 grievances have been resolved.
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