Ayushman Bharat Pradhan Mantri Jan Arogya Yojana

• IAS NEXT, Lucknow
• 27, Nov 2021

Reference News:

Summary findings from the fifth edition of the National Family Health Survey, released recently showed a 12.3 percentage point increase over the previous edition of the survey in the coverage of health insurance to 41% of households surveyed, an indication of the impact of the government’s flagship the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana(AB-PMJAY), that was launched in September 2018.

Key Features of PM-JAY:

1. The world’s largest health insurance/ assurance scheme fully financed by the government.
2. It provides cover of 5 lakhs per family per year, for secondary and tertiary care hospitalization across public and private empaneled hospitals in India.
3. Coverage: Over 10.74 crore poor and vulnerable entitled families (approximately 50 crore beneficiaries) are eligible for these benefits.
4. Provides cashless access to health care services for the beneficiary at the point of service.
5. The National Health Authority (NHA) is the nodal agency responsible for the nationwide roll-out and implementation of the AB-PMJAY scheme.
6. This scheme is a Centrally sponsored scheme with some Central sector components.

Eligibility:

1. No restrictions on family size, age or gender.
2. All pre–existing conditions are covered from day one.
3. Covers up to 3 days of pre-hospitalization and 15 days post-hospitalization expenses such as diagnostics and medicines.
4. Benefits of the scheme are portable across the country.
5. 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.
6. Public hospitals are reimbursed for the healthcare services at par with the private hospitals.

As per the latest economic survey:

1. The Pradhan Mantri Jan Arogya Yojana (PM-JAY) contributed to improvement in many health outcomes in States that implemented the programme.
2. States that joined the PM-JAY, compared to those that did not, experienced greater penetration of health insurance, reduction in infant and child mortality rates, realised improved access and utilisation of family planning services and greater awareness of HIV/AIDS.
3. Across all the States, the proportion of households with health insurance increased by 54% for States that implemented PM-JAY while falling by 10% in States that did not.