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Ayushman Bharat-Pradhan Mantri Jan Arogya Yojana (PM-JAY) which completed a year on 23 September 2019 has recorded 46.4 lakh hospital treatments worth ₹7,500 crores with 60% of the amount being spent on tertiary care.

  • As per the figures released by PM-JAY, this has resulted in the saving of over ₹12,000 crores to the beneficiary families.
Ayushman Bharat
  • Ayushman Bharat is a flagship scheme of Government of India was launched as recommended by the National Health Policy 2017, to achieve the vision of Universal Health Coverage (UHC).
  • Ayushman Bharat is an attempt to move from sectoral and segmented approach of health service delivery to a comprehensive need-based health care service.
  • Ayushman Bharat aims to undertake path-breaking interventions to holistically address health covering prevention, promotion and ambulatory care, at primary, secondary and tertiary level.
  • Currently, 32 States and Union Territories are implementing the scheme and more than 10 crore beneficiary cards have been issued.
  • Ayushman Bharat adopts a continuum of care approach, comprising of two interrelated components, which are -
  1. Health and Wellness Centres (HWCs)
  2. Pradhan Mantri Jan Arogya Yojana (PM-JAY)
  1. Health and Wellness Centers (HWCs)
  • In February 2018, the Government of India announced the creation of 1,50,000 Health and Wellness Centres (HWCs) by transforming existing sub-centers and Primary Health Centres.
  • These centers would deliver Comprehensive Primary Health Care (CPHC) bringing healthcare closer to the homes of people covering both maternal and child health services and non-communicable diseases, including free essential drugs and diagnostic services.
  1. Pradhan Mantri Jan Arogya Yojana (PM-JAY)
  • The second component PM-JAY aims at providing a health insurance cover of Rs. 5 lakhs per family per year for secondary and tertiary care hospitalization to over 10.74 crores poor and vulnerable families (approximately 50 crore beneficiaries).
  • There is no cap on the family size under the scheme.
  • This scheme was earlier known as National Health Protection Scheme (NHPS) before it was rechristened to PM-JAY.
  • This scheme was launched on 23rd September 2018 by Prime Minister Shri Narendra Modi in Ranchi, Jharkhand.
  • PM-JAY has been rolled out for the bottom 40% of the poor and vulnerable population.
  • The households included are based on the deprivation and occupational criteria of Socio-Economic Caste Census 2011 (SECC 2011) for rural and urban areas respectively.
  • The scheme subsumed then existing Rashtriya Swasthya Bima Yojana (RSBY), launched in 2008.
  • Therefore, the coverage mentioned under PM-JAY also includes families that were covered in RSBY but were not present in the SECC 2011 database.
  • PM-JAY is completely funded by the Government, and the cost of implementation is shared between Central and State Governments.
Key Features of PM-JAY Pradhan Mantri Jan Arogya Yojana
  • PM-JAY is the world’s largest health insurance/ assurance scheme fully financed by the government.
  • Covers up to 3 days of pre-hospitalization and 15 days post-hospitalization expenses such as diagnostics and medicines
  • Benefits of the scheme are portable across the country i.e. a beneficiary can visit any impaneled public or private hospital for cashless treatment.
  • Services include approximately 1,393 procedures covering all the costs related to treatment, including but not limited to drugs, supplies, diagnostic services, physician's fees, room charges, surgeon charges, OT and ICU charges, etc.
  • Public hospitals are reimbursed for the healthcare services at par with the private hospitals.
Issues with the Scheme
  • Though after a year PM-JAY has impressive numbers to show it still faces challenges of sustainability, synchronization and financial fulfillment.
  • Other problems are increasing population, disease burden, the concentration of health services in urban areas, and lack of awareness of the scheme among a major chunk of entitled beneficiaries.
  • The uneven geographic distribution of poor families also makes it difficult to find out the real targeted beneficiaries.
  • According to public health experts, Ayushman Bharat lacks in rational pricing and health insurance for all as it covers only a section of the population.
  • The poor in India systematically report lower rates of reported illness, medical attention-seeking and hospitalization than the rich. The poorest states are not the ones seeking the most medical attention
  • There are some inclusion errors. Example- The scheme was being most widely used for procedures including dialysis, cataract, and cesarean deliveries that were in many cases covered by other existing government schemes.
  • The high rate of hysterectomies conducted under the scheme has also raised concerns.
Conclusion
  • Public health experts have said that along with delivery and quality, the government will need to adopt innovative funding models for long-term sustainability.
  • There is little doubt that the scheme has improved access to hospitalization across the country, with large numbers of beneficiaries enrolled and a high insurance cover. However, it is not yet clear that the scheme is helping the most vulnerable cross existing barriers to access medical help and be protected from excess interventions.
  • Given the large public spending on the program, greater transparency and more data are sorely needed to evaluate these issues.
Also read: Ayushman Bharat Yojana: National Health Protection Scheme (AB-NHPS) PM-JAY head approaches Delhi again Source 1 Source 2 Source 3 Source 4