Ayushman Bharat – Pradhan Mantri Jan AarogyaYojana (AB-PMJAY)

Ayushman Bharat – Pradhan Mantri Jan AarogyaYojana (AB-PMJAY)

Subject: Government Schemes

Context:

The National Health Authority (NHA) may see a nominal increase in fund allocation in the upcoming union budget for 2023.

Ayushman Bharat – Pradhan Mantri Jan AarogyaYojana (AB-PMJAY)

• Ayushman Bharat is a progression towards Universal Health Care through access of Health and Wellness Centers (HWCs) at the primary level and provision of financial protection for accessing curative care at the secondary and tertiary levels through engagement with both public and private sector.
• Two components:
  • Creation of 1,50,000 Health and Wellness Centres– to provide Comprehensive Primary Health Care (CPHC), covering both maternal and child health services and non-communicable diseases, including free essential drugs and diagnostic services.
  • Pradhan Mantri Jan ArogyaYojana (PMJAY) which provides health protection cover to poor and vulnerable families for secondary and tertiary care.

Pradhan Mantri Jan ArogyaYojana (PMJAY)

• AB-PMJAY was launched  by the Prime Minister on 23rd September, 2018.
• It is the “world’s largest government funded healthcare program” targeting more than 50 crore beneficiaries.
  • Over 10.74 crore vulnerable entitled families (approximately 50 crore beneficiaries) are eligible for these benefits.
• It provides a cover of up to Rs. 5 lakhs per family per year, for secondary and tertiary care hospitalization.
  • The family cap is of five members.
• It covers up to 3 days of pre-hospitalization and 15 days of post- hospitalization expenses such as diagnostics and medicines.
• PMJAY provides cashless and paperless access to services for the beneficiary at the point of service.
• NHA is the apex implementing agency of Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (PM-JAY).
• PM-JAY offers 1,949 treatment procedures across 27 medical specialties.
• Eligibility:
  • The households included are based on the deprivation and occupational criteria of Socio-Economic Caste Census 2011 (SECC 2011) for rural and urban areas respectively.
  • The coverage mentioned under PM-JAY, therefore, also includes families that were covered in RSBY but are not present in the SECC 2011 database.
• Cover Under PM-JAY-includes all expenses incurred on the following components of the treatment.
  • Medical examination, treatment and consultation
  • Pre-hospitalization
  • Medicine and medical consumables
  • Non-intensive and intensive care services
  • Diagnostic and laboratory investigations
  • Medical implantation services (where necessary)
  • Accommodation benefits.
  • Food services
  • Complications arising during treatment
  • Post-hospitalization follow-up care up to 15 days