Ayushman Bharat – Pradhan Mantri Jan Arogya Yojana

Ayushman Bharat

The National Health Policy 2017 advised the commencement of Ayushman Bharat, the government of India’s flagship programme, in order to realise the goal of Universal Health Coverage (UHC). The Sustainable Development Goals (SDGs) and its central commitment to “leaving no one behind” have been addressed through this project.

Ayushman Bharat represents an effort to transition from a sectoral and fragmented approach to the delivery of health services to a comprehensive need-based strategy. This programme intends to implement ground-breaking initiatives to comprehensively address the healthcare system at the primary, secondary, and tertiary levels (encompassing prevention, promotion, and ambulatory care). The continuum of care strategy used by Ayushman Bharat consists of two interconnected parts, which are.(Ayushman Bharat)

  1. Health and Wellness Centres (HWCs)
  2. Pradhan Mantri Jan Arogya Yojana (PM-JAY)

Health and Wellness Centers (HWCs)

The Government of India stated in February 2018 that it will turn the current Sub Centers and Primary Health Centers into 1,50,000 Health and Wellness Centers (HWCs). These facilities will provide Comprehensive Primary Health Care (CPHC), bringing medical services closer to people’s homes. They include free basic medications and diagnostic services for non-communicable illnesses as well as services for maternity and child health.

The goal of health and wellness centres is to provide a wider range of services to meet the primary healthcare requirements of the local population as a whole, increasing accessibility, universality, and equity near to the community. The goal of health promotion and prevention is to keep people healthy by motivating and enabling people to make healthy decisions and alter their lifestyles in order to lower their chance of contracting chronic illnesses and morbidities.(Ayushman Bharat)

Pradhan Mantri Jan Arogya Yojana (PM-JAY)

The Pradhan Mantri Jan Arogya Yojna, or PM-JAY as it is more often known, is the second element of Ayushman Bharat. On September 23, 2018, the Hon. Prime Minister of India, Shri Narendra Modi, unveiled this programme in Ranchi, Jharkhand.

the Ayushman Bharat The largest health assurance programme in the world, PM-JAY, aims to cover secondary and tertiary care hospitalisation for over 10.74 crores vulnerable and poor families (roughly 50 crore beneficiaries), who make up the bottom 40% of the Indian population, for a total of Rs. 5 lakhs per family per year. The households included are based on the socioeconomic caste census 2011’s (SECC 2011) occupational and deprivation categories for rural and urban regions, respectively. Prior to being renamed, PM-JAY was formerly known as the National Health Protection Scheme (NHPS). Rashtriya Swasthya Bima Yojana (RSBY), which had been introduced in 2008, was absorbed into it at the time.

Therefore, the families that were covered in RSBY but are not included in the SECC 2011 database are also included in the coverage specified under PM-JAY. The cost of implementing PM-JAY is split between the Central and State Governments, with all funding coming from the government.(Ayushman Bharat)

Key Features of PM-JAY

  1. PM-JAY is the world’s largest health insurance/ assurance scheme fully financed by the government.
  2. It provides a cover of Rs. 5 lakhs per family per year for secondary and tertiary care hospitalization across public and private empanelled hospitals in India.
  3. Over 10.74 crore poor and vulnerable entitled families (approximately 50 crore beneficiaries) are eligible for these benefits.
  4. PM-JAY provides cashless access to health care services for the beneficiary at the point of service, that is, the hospital.
  5. PM-JAY envisions to help mitigate catastrophic expenditure on medical treatment which pushes nearly 6 crore Indians into poverty each year.
  6. It covers up to 3 days of pre-hospitalization and 15 days post-hospitalization expenses such as diagnostics and medicines.
  7. There is no restriction on the family size, age or gender.
  8. All pre–existing conditions are covered from day one.
  9. Benefits of the scheme are portable across the country i.e. a beneficiary can visit any empanelled public or private hospital in India to avail cashless treatment.
  10. 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.
  11. Public hospitals are reimbursed for the healthcare services at par with the private hospitals.
Benefit Cover Under PM-JAY

Benefit coverage under different government-funded health insurance plans in India has always been capped at an annual amount ranging from INR30,000 to INR3,00,000 per family across several States, which has led to a disjointed system. Each qualified household is provided cashless coverage of up to INR 5,00,000 year under PM-JAY for the aforementioned secondary and tertiary care problems. The following costs related to the therapy are all covered by the scheme’s insurance.(Ayushman Bharat)

  1. Medical examination, treatment and consultation
  2. Pre-hospitalization
  3. Medicine and medical consumables
  4. Non-intensive and intensive care services
  5. Diagnostic and laboratory investigations
  6. Medical implantation services (where necessary)
  7. Accommodation benefits
  8. Food services
  9. Complications arising during treatment
  10. Post-hospitalization follow-up care up to 15 days

The benefits of INR 5,00,000 are family floater benefits, therefore any one or all family members may use them. There was a five-person family limit for the RSBY. However, based on the lessons learned from previous programmes, PM-JAY was created with no restrictions on family size or member ages. Additionally, pre-existing conditions are covered right away. This implies that on the day they participate in the programme, every eligible person who has ever had a medical condition that was not previously covered by PM-JAY will be able to get treatment for all of those ailments as well.(Ayushman Bharat)

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