In recent news, approximately 20.32 lakh Covid-19 tests and 7.08 lakh treatments were authorized under the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB PM-JAY) from April 2020 to July 2021. The scheme comes with a provision of a sum insured of Rs.5 lakh per family, which covers secondary care (excluding super specialist services) and tertiary care (including super specialist services). Beneficiaries enjoy cashless and paperless access to services at the point of service under PMJAY health benefit packages.
Key Features of the PMJAY Scheme
PMJAY offers packaged rates that include an all-inclusive cost, thus avoiding separate charges for individual products or services. Once the rate is fixed by hospitals, they cannot charge the beneficiaries extra. The plan also imposes a daily limit on medical management.
Beneficiaries and Funding of the Scheme
This entitlement-based scheme uses the latest Socio-Economic Caste Census (SECC) data to identify the beneficiaries. The funding model varies with geographic regions: a 60:40 ratio for states and UTs with their own legislature, 90:10 for Northeast states, and Jammu and Kashmir, Himachal, and Uttarakhand, and 100% Central funding for UTs without a legislature.
Nodal Agencies Involved
National Health Authority (NHA) is an autonomous entity that works in conjunction with state governments for effective implementation of PM-JAY. On the other hand, the State Health Agency (SHA) represents the state government and is accountable for implementing AB PM-JAY in the state.
Challenges in Implementing the PMJAY Scheme
Cooperation of states is crucial since health is a state subject and they are expected to contribute 40% of funds. Streamlining state health insurance schemes with PMJAY has been a significant challenge. Several states, including West Bengal, Telangana, Odisha, and Delhi, have not implemented the scheme. The cost burden, inadequate health capacities, and unnecessary treatments are other challenges faced by stakeholders.
Achievements of the PMJAY Scheme
PM-JAY has significantly benefited the underprivileged, with more than 20.8 lakh individuals receiving free treatment worth over Rs. 5,000 crores in the first 200 days of its implementation. One of the key features of the scheme, portability, allows eligible migrant workers to access the services in any empaneled hospital across the country.
Related Schemes: India Covid-19 Emergency Response & Health System Preparedness Package: Phase-II (ECRP-II package)
The ECRP-II package aims to boost health system preparedness for immediate responsiveness towards early prevention, detection, and management, focusing on health infrastructure development, including for Paediatric Care, with measurable outcomes.
The Way Forward and Public Expenditure on Healthcare in India
To meet the Universal Health Coverage (UHC) goals, AB-PMJAY’s extensive ambition presents an opportunity to introduce necessary systemic reforms. While it would require an injection of resources into the chronically underfunded health system, it would also need to address governance, quality control, and stewardship issues. Public expenditure on healthcare in India remains one of the lowest globally. However, incorporating technology and innovation can significantly reduce healthcare costs. AI-powered mobile applications can offer high-quality, low-cost, patient-centric, smart wellness solutions. The scalable and interoperable IT platform for Ayushman Bharat is a stride in this direction.
