Government initiative to improve PMJAY

Source: The post government initiative to improve PMJAY has been created, based on the article “How Ayushman Bharat is saving lives” published in “Indian Express” on 7th October is 2024

UPSC Syllabus Topic: GS Paper 2- Governance -Welfare schemes for vulnerable sections of the population by the Centre and States and the performance of these schemes.

Context: The article discusses the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY), a healthcare scheme in India. It highlights its impact on providing free medical treatment to families, especially the poor and elderly, improving healthcare access and reducing financial burdens due to medical expenses.

For detailed information on Expansion of the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB PM-JAY) read Article 1, Article 2

What is Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY)?

The AB-PMJAY is a health insurance scheme in India that provides free healthcare to families for secondary and tertiary medical treatments up to Rs 5 lakh annually. It has been a critical part of India’s approach to Universal Health Coverage (UHC).

What are the key benefits of PMJAY?

1. Financial Protection: It covers up to Rs 5 lakh per family annually for secondary and tertiary healthcare, preventing impoverishment due to medical expenses.
2. Widespread Access: The scheme has facilitated 7.8 crore hospital admissions in six years, benefiting millions.
3. Comprehensive Healthcare: PMJAY covers inpatient care, while over 1,75,000 Ayushman Arogya Mandirs provide free consultations, medicines (up to 172), and diagnostics (up to 63) for outpatient services.
4. Support for Elderly: The scheme now benefits 4.5 crore families, covering about 6 crore senior citizens. The hospitalisation rate for those over 70 exceeds 11%.
5. Inclusive Coverage: Unlike private insurance, PMJAY doesn’t exclude those with pre-existing conditions or impose waiting periods, benefiting 58% elderly women, many of whom are widows.
6. Reduced Financial Vulnerability: Studies show the bottom 50% of the population is now less vulnerable to medical expenses.

How is the government improving PMJAY?

1. Expansion of Health Benefit Package (HBP): The procedures covered under PMJAY increased from 1,393 in 2018 to 1,949 by 2022. This allows more treatments under the scheme.
2. Introduction of Differential Pricing: To account for regional cost variations, differential pricing was introduced, enabling more accurate pricing for healthcare services.
3. Flexibility for States: States and Union Territories were given additional flexibility to customize HBP rates to suit local healthcare needs.
4. Extended Coverage: In 2022, PMJAY was extended to approximately 37 lakh ASHA and Anganwadi workers’ families.
5. Elderly Coverage: The scheme now covers all citizens aged 70 and above, benefiting around 6 crore senior citizens.
6. Hospital Network Expansion: PMJAY has empanelled over 29,000 hospitals, with 57% of admissions happening in the private sector.
7. Public Hospital Improvement: Public hospitals have utilized reimbursed funds to upgrade infrastructure and amenities under PMJAY.

Question for practice:

Discuss the key benefits of the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) in improving healthcare access and reducing financial vulnerability.