Introduced in February 2018, Ayushman Bharat-Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) is the world’s largest government-funded healthcare scheme. Launched as part of the National Health Policy 2017, this flagship initiative aims to provide Universal Health Coverage (UHC) by offering an insurance cover of Rs.5 lakh per family for secondary and tertiary care.
Main Components of the Scheme
AB-PMJAY has two vital components: the establishment of Health and Wellness Centres (HWCs) and the implementation of the PM-JAY insurance program. Through this scheme, beneficiaries can access cashless and paperless services at hospitals, which include surgery, medical treatments, cost of medicines and diagnostics. All these services are available at fixed rates, ensuring that hospitals cannot charge more than the amount stipulated by the government.
Key Beneficiaries of the Scheme
This entitlement-based initiative targets beneficiaries identified through the latest Socio-Economic Caste Census (SECC). Once included in the database, individuals are considered insured and can avail services from any empanelled hospital.
Funding Framework
The funding for PM-JAY is shared. It’s divided in a 60:40 ratio for states and Union Territories (UTs) with their own legislature, 90:10 in Northeast states and Jammu and Kashmir, Himachal and Uttarakhand and 100% Central funding for UTs without legislature.
Implementing Agencies
National Health Authority (NHA), constituted under the Society Registration Act, 1860, oversees effective implementation of PM-JAY in collaboration with state governments. The State Health Agency (SHA) of each state is primarily responsible for implementing it in their respective states.
Challenges in Implementing PMJAY
Key challenges in the implementation include obtaining cooperation from states, managing the cost burden, improving insufficient health capacities, and preventing unnecessary treatments. Additionally, some states like West Bengal and Odisha have not implemented PM-JAY yet.
Achievements of the Scheme
In its initial phases, PM-JAY benefitted over 20.8 lakh underprivileged individuals who received free treatment worth more than Rs. 5,000 crores. The scheme also proved instrumental during the Covid-19 pandemic by providing portable services across nationwide empanelled hospitals to migrant workers, irrespective of their state of residence.
Future Direction
The ambitious AB-PMJAY program presents an opportunity to revamp India’s healthcare system and achieve its Universal Health Coverage (UHC) goals. While this would require substantial resources, it also demands attention towards quality control, governance, and stewardship to sustainably move India towards UHC. Leveraging technology and innovation can further reduce healthcare costs. For instance, AI-enabled mobile applications can offer high-quality, affordable, patient-focused smart wellness solutions. The scalable and interoperable IT platform for Ayushman Bharat reflects a step in this direction.