Ayushman Bharat – Pradhan Mantri Jan Arogya Yojana

  • August 14, 2021
  • Posted by: OptimizeIAS Team
  • Category: DPN Topics
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Ayushman Bharat – Pradhan Mantri Jan Arogya Yojana

Subject – Governance

Context – AB-PMJAY gave Rs.2794cr for COVID treatment

Concept –

  • Ayushman Bharat is a flagship initiative that attempts to move away from the sectoral and segmented approach of service delivery to a comprehensive need-based health care service. It has been launched by the government with an aim to move towards a provision of universal healthcare in the country.
  • Ayushman Bharat adopts a two-pronged approach:
    • Firstly, the creation of health and wellness centres to bring health care closer to homes.
    • Secondly, the formulation of a Pradhan Mantri Jan Arogya Yojana (PMJAY)to protect poor and vulnerable families against financial risk arising out of catastrophic health episodes.
  • PMJAY offers a sum insured of Rs.5 lakh per family for secondary care (which doesn’t involve a super specialist) as well as tertiary care (which does). For the beneficiaries, this is a free scheme.
  • It is an entitlement-based scheme that targets the beneficiaries as identified by latest Socio-Economic Caste Census (SECC) data.
  • Individuals can walk into any empanelled hospital that can process cashless payments.
  • Once identified by the database, the beneficiary is considered insured.
  • The insurance cost is shared by the centre and the state mostly in the ratio of 60:40.
  • Empanelled hospitals agree to the packaged rates under PMJAY—there are about 1,400 packaged rates for various medical procedures under the scheme.
    • These packaged rates also mention the number of average days of hospitalization for a medical procedure and supporting documents that are needed.
    • These rates are flexible, but once fixed hospitals can’t change it and under no circumstances can they charge the beneficiary. The scheme also has prescribed a daily limit for medical management.
  • National Health Agencyhas been constituted as an autonomous entity under the Society Registration Act, 1860 for effective implementation of PMJAY in alliance with state governments.
Ayushman Bharat - Pradhan Mantri Jan Arogya Yojana Governance