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Ayushman Bharat PM-JAY:

GS Paper 2

Topics Covered: Issues related to health.

 

Context:

Under the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY), the Union government’s health insurance scheme, approximately 20.32 lakh COVID-19 tests and 7.08 lakh treatments were authorised from April 2020 to July 2021.

  • The total value of the tests and treatment stood at ₹2,794 crore.

 

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.

 

Insta Curious:

Did you know that the National Health Authority has also been given the responsibility to implement the National Digital Health Mission? Reference

 

InstaLinks:

Prelims Link:

  1. Components of Ayushman Bharat.
  2. PMJAY- Key features.
  3. Eligibility.
  4. About the National Health Agency.
  5. SEHAT scheme.

Mains Link:

Discuss the significance and potential of PMJAY.

Sources: the Hindu.