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 Table of Contents  
ORIGINAL ARTICLE
Year : 2019  |  Volume : 6  |  Issue : 4  |  Page : 182-186

Patients’ perceived service quality for Mahatma Jyotiba Phule Jan Arogya Yojana: A study conducted at tertiary care hospital in Raigad district


1 Department of Hospital Administration, MGM School of Biomedical Sciences, MGM Institute of Health Sciences, Kamothe, Maharashtra, India
2 MGM Hospital, Kamothe, Maharashtra, India

Date of Submission18-Jan-2020
Date of Acceptance21-Jan-2020
Date of Web Publication29-Apr-2020

Correspondence Address:
Dr. Rupali Gujar
Department of Hospital Administration, MGM School of Biomedical Sciences, MGM Institute of Health Sciences, Kamothe, Navi Mumbai 410209, Maharashtra.
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/mgmj.mgmj_5_20

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  Abstract 

Introduction: Mahatma Jyotiba Phule Jan Arogya Yojana (MJPJAY) is a state governments’ health insurance scheme of free quality critical care for low income families. Aim: The aim of this study was to assess the patients’ awareness about the MJPJAY scheme and to study patients’ perception about the scheme through Service Quality (SERVQUAL) at tertiary care hospital. Materials and Methods: A total of 100 exit interviews of MJPJAY beneficiaries (patients) were conducted through structured questionnaire over 6 months’ study period, who availed the services of MJPJAY. Results were analyzed by descriptive statistics and displayed in the form of percentage. Service quality has been measured with “SERVQUAL” a scale to assess the perception of MJPJAY beneficiaries. Results: A total of 100, 71% males and 29% females benefitted by the scheme. The mean age of MJPJAY beneficiaries was 20 years. The SERVQUAL score of MJPJAY services provided at tertiary care hospital was found to be satisfactory at 4 rating on Likert scale for all five dimensions. Conclusion: In this study, their perception has been measured by service quality (SERVQUAL) tool, consisting a set of questions that mainly focuses on soft skills used by service provider, which allows patients to express their opinion regarding services rendered to them by the hospital.

Keywords: Health insurance, Mahatma Jyotiba Phule Jan Arogya Yojana, Raigad, Rajiv Gandhi Jeevandayee Arogya Yojana, SERVQUAL, tertiary care hospital


How to cite this article:
Gujar R, Mishra A, Salgotra KR. Patients’ perceived service quality for Mahatma Jyotiba Phule Jan Arogya Yojana: A study conducted at tertiary care hospital in Raigad district. MGM J Med Sci 2019;6:182-6

How to cite this URL:
Gujar R, Mishra A, Salgotra KR. Patients’ perceived service quality for Mahatma Jyotiba Phule Jan Arogya Yojana: A study conducted at tertiary care hospital in Raigad district. MGM J Med Sci [serial online] 2019 [cited 2020 Oct 31];6:182-6. Available from: http://www.mgmjms.com/text.asp?2019/6/4/182/283463




  Key message: Top


Service quality measurement in health-care sector is challenging because it is intangible, heterogenic, inseparable, and perishable. So, to measure the service quality in health care, experts use perceptions and expectations. In this study, SERVQUAL was used to measure patients� perception about MJPJAY scheme.


  Introduction Top


Mahatma Jyotiba Phule Jan Arogya Yojana (MJPJAY) is a Maharashtra Government’s initiative for making health care access to lower socioeconomic section of the society. Beneficiaries can seek medical care in empaneled tertiary hospital, and the expenses are taken care of by the government. It works under State Health Assurance Society. The main objective of the society is “to conceptualize, implement, establish, provide, administer, modify and supervise directly or indirectly by means of Mahatma Jyotiba Phule Jan Arogya Yojana.”[1] The MJPJAY scheme was initially launched in 8 districts of the state of Maharashtra in July 2012, followed by all 35 districts in November 2013, it was formerly known as Rajiv Gandhi Jeevandayee Arogya Yojana (RGJAY).

MJPJAY mainly works for the objective “to improve access of below poverty line (BPL) and above poverty line (APL) families (excluding white card holders as defined by Civil Supplies Department) to quality medical care for identified specialty services requiring hospitalization for surgeries and therapies or consultations through an identified network of health care providers.”[2] It ensures cashless coverage of INR 150,000 per family per year in any empaneled hospital to eligible beneficiary families. This amount can be availed by one family member or collectively by all members of the family who have their names in the family ration card. Community is benefited by the scheme, which caters almost 971 surgeries, therapies, procedures, and 121 follow-up packages. The 132 procedures were performed only in empaneled government hospital/government medical college.

In particular, Raigad district has 10 hospitals empaneled, including private tertiary care hospital, multispecialty hospitals, research center, and public hospitals.

The study was based on perceived service quality among patients of MJPJAY in Raigad district in Maharashtra. When the patients visit the hospitals with their expectations, which are based on many factors (needs, demography, or word of mouth feedback), it is important that the hospital should provide the services accordingly. For these patients, if perceptions exceed expectations; it will be regarded as good or adequate services, whereas the perceived services below the expectations account for grievances against the hospital.

Service quality measurement in health-care sector is challenging because it is intangible, heterogenic, inseparable, and perishable. So, to measure the service quality in health care, experts have used perceptions and expectations. There are many studies in which researchers use SERVQUAL (developed by Parasuraman et al.[3]). A scale based on five service quality dimensions known as “Tangibles,” “Reliability,” “Responsiveness,” “Assurance,” and “Empathy” was used.[3]

The objectives of this study were as follows:

  1. To assess the patients’ awareness about the MJPJAY scheme in a tertiary care hospital


  2. To study the patients’ perceptions about the MJPJAY services after availing the facilities in a tertiary care hospital


  3. To study overall patients’ satisfaction and service quality dimensions



  Materials and methods Top


The study was based on application of the SERVQUAL—a scale that has been used to assess the perception of MJPJAY beneficiaries.

Study design

It was a cross-sectional study. The exit interviews were conducted with patients who availed the services of MJPJAY. A detailed interview was performed with structured questionnaire followed by informed consent.

Study subjects

Study subjects included 100 MJPJAY beneficiaries (patients) who were admitted in tertiary care hospital under MJPJAY scheme.

Duration of the study

This study lasted six months (July 2018 to December 2018).

Inclusion criteria

  • Patients admitted for the first time under MJPJAY scheme in hospital.


  • Inpatient department patients admitted minimum for 3 days.


  • Outpatient department patients who came for first follow-up.


  • Exclusion criteria

  • Hospital employees admitted under MJPJAY scheme in hospital.


  • Study tool

    Modified validated SERVQUAL questionnaire comprising 46 questions on demographic information, knowledge about the scheme, and overall feedback about the scheme. A total of 22 questions on SERVQUAL, regarding tangibles, reliability, responsiveness, assurance, and empathy have been used explicitly.


    Click here to view



      Results and discussion Top


    1. In the study period, beneficiaries were from pediatric age-group to geriatric population; of which, 71% males and 29% females benefitted by the scheme. The mean age of MJPJAY beneficiaries was 20 years. Of the total beneficiaries, 82% orange ration card holders (APL) were the highest beneficiaries of MJPJAY scheme and 18% had yellow ration card (BPL); 46% and 54% beneficiaries were from joint and nuclear families, respectively. None of them possessed Antyodya and Annapurna ration cards [Figure 1].


    2. High awareness (score 5) was shown by beneficiaries in MJPJAY schemes’ aim and eligibility criteria. Moderate awareness (score 4) was found in the knowledge of empaneled hospitals in Raigad district. But most important features of scheme, per family annual insurance covered and number of diseases covered under scheme, were found to have very low or no awareness [Table 1] and [Figure 2].


    3. Reasons to avail services from this hospital: 24% beneficiaries preferred this hospital on its quality and reputation. Along with other reasons such as proximity to house and referral from camps and other hospitals, 8% beneficiaries mentioned the reason of availability of MJPJAY scheme in the hospital [Table 2] and [Figure 3].


    4. Of the total beneficiaries, 13% lodged grievances against hospital, from which 69% grievances were for out of pocket (OOP) expenditure, of which 64% were for medicine purchases. Other common complaints were about delay in treatment, lengthy discharge procedure, and system failure at the time of registration process [Table 3].


    5. Overall satisfaction scores on Likert scale [Figure 4] were as follows:



      • a. Services provided by MJPJAY scheme found to be moderately satisfied (score 4)


      • b. Working of grievance redressal cell found to be moderately satisfied (score 4)


      • c. Awareness campaign of the scheme found to be satisfactory (score 3)


    6. Of the total beneficiaries, 52% said they would have borrowed money as an alternate source of money to fund treatment in the absence of the scheme, 10% said they would have taken loan from bank, 12% said they would have used their savings, and 14% said they would not have been able to undergo treatment [Table 4] and [Figure 5].


    7. Overall SERVQUAL score on Likert scale was moderately satisfied (score 4) [Table 5] and [Figure 6].
    Figure 1: Profile of the beneficiaries

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    ,
    Table 1: Awareness about Mahatma Jyotiba Phule Jan Arogya Yojana scheme

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    ,
    Figure 2: Awareness about scheme

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    ,
    Table 2: Reasons to avail services from this hospital

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    ,
    Figure 3: Reasons to avail services from this hospital

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    ,
    Table 3: Out of pocket expenses and grievance

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    ,
    Figure 4: Overall satisfaction by beneficiaries about scheme on Likert scale

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    ,
    Table 4: Importance of Mahatma Jyotiba Phule Jan Arogya Yojana scheme

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    ,
    Figure 5: Importance of Mahatma Jyotiba Phule Jan Arogya Yojana scheme: In the absence of the scheme the alternate source of money to fund the treatment

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    ,
    Table 5: Analysis of service quality (SERVQUAL)

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    ,
    Figure 6: Total SERVQUAL mean score

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    SERVQUAL has five dimensions with 22 parameters, which include tangibles, reliability, responsiveness, assurance, and empathy. Likert scale has been used to obtain feedback from participants.


      Conclusion Top


    The objective of the scheme was to improve the access to quality health care of the economically weaker section through public private partnership.[4] Scheme emphasizes on quality health care;[5] however, the quality parameters are not defined at policy, practice, and service level. To measure quality of services rendered to them by the hospital, MJPJAY official/system administration needs to include the service quality tool (SERVQUAL), which mainly focuses on soft skills used by service provider, which allows patients to express their opinion regarding services.

    1. At policy level, MJPJAY office bearers need to address the SERVQUAL in MJPJAY empaneled hospital for quality check.


    2. At practice level, the hospital authorities have to ensure the quality as well. If quality care has been ensured at hospital level, appreciation to hospital also is given by MJPJAY society. One of the examples is MGM Hospital, Kamothe, Raigad district, has been awarded for best patient care hospital.


    3. At patient level, awareness of patients’ rights and responsibilities regarding MJPJAY scheme has to be ensured by hospital personnel time and again. National Accredited Board of Hospitals has also dedicated one chapter on patient’s rights.


    Limitations

    The study was conducted only in one tertiary care hospital in rural area. Inclusion of urban population will put more light on the perception of service quality of MJPJAY.

    Acknowledgement

    We sincerely share our gratitude for faculties of Department of Community Medicine, MGM Medical College, Kamothe, for their support and guidance, with special mention of Dr. Rajesh Goel, for critical evaluation of the paper.

    Financial support and sponsorship

    Nil.

    Conflicts of interest

    There are no conflicts of interest.



     
      References Top

    1.
    Bhaisare R, Mankar M, Goel R, Anjenaya S, Sawardekar P, Thatkar P, et al. To assess the knowledge of Rajiv Gandhi Jeevandayee Arogya Yojana (RGJAY) among medical interns at tertiary care hospital in Raigad district, Maharashtra. Int J Recent Trends Sci Tech 2014;13: 279-82.  Back to cited text no. 1
        
    2.
    Mahatma Jyotiba Phule Jan Arogya Yojana: Free Quality Critical Care for Low Income Families. Available from: https://www.jeevandayee.gov.in/MJPJAY. [Last accessed on 2019 Nov 10].  Back to cited text no. 2
        
    3.
    Parasuraman A, Zeithaml VA, Berry LL. A conceptual model of service quality and its implications for future research. J Mark 1985;49: 41-50.  Back to cited text no. 3
        
    4.
    Wagle S, Shah N. Government Funded Health Insurance Scheme in Maharashtra: Study of Rajiv Gandhi Jeevandayee Aarogya Yojana. Mumbai, India: CEHAT, 2017. p. 136.  Back to cited text no. 4
        
    5.
    Arora E. Adapting the service quality (SERV-QUAL) scale to assess the hospital services in Delhi/NCR: An empirical study determining patient satisfaction. Navi Mumbai:MGM Institute of Health Sciences, 2016. Ph D Thesis.  Back to cited text no. 5
        


        Figures

      [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6]
     
     
        Tables

      [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6]



     

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