PM- JAY

PM- JAY

Subject : Government Schemes

Context : The Pradhan Mantri Jan ArogyaYojana (PM-JAY) contributed to improvement in many health outcomes in States that implemented the ambitious programme  to provide healthcare access to most vulnerable sections, according to the Economic Survey 2020-21.

Concept :

• 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.
• 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.

Pradhan Mantri Jan ArogyaYojana (PMJAY)

• PMJAY offers a sum insured of 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.
• National Health Agency has been constituted as an autonomous entity under the Society Registration Act, 1860 for effective implementation of PMJAY in alliance with state governments.