Editorial 1 : Stories of Health and Hope
Context: How Ayushman Bharat is saving lives
Performance of Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY)
- PMJAY forms the foundation of healthcare delivery across government and private hospitals by providing free healthcare of up to Rs 5 lakh for secondary and tertiary treatment per beneficiary family.
- The scheme is a testament to India’s commitment to Universal Health Coverage (UHC).
- With approximately 7.8 crore hospital admissions authorised under the scheme over the last six years, PMJAY has saved millions of lives and prevented the impoverishment of their families due to hospital costs.
- It is life-changing and life-saving for millions of families.
Ayushman Arogya Mandirs (AAMs)
- PMJAY is for inpatient secondary and tertiary care. Outpatient services are not a part of the scheme.
- The outpatient services component of Universal Health Coverage (UHC) is addressed through comprehensive primary health care mission under which over 1,75,000 Ayushman Arogya Mandirs (AAMs), earlier called Health and Wellness Centres, have been established.
- In AAMs free consultations and many medicines (up to 172) and diagnostics (up to 63) are being provided free.
Universal Health Coverage (UHC)
- The government is focusing on stronger two-way convergence and continuity of care across the two systems.
- Bharat’s UHC model is based on a public-funded comprehensive primary healthcare.
- Health policy and services need to be seen in totality and not in isolation.
Features and Coverage under PMJAY
- PMJAY connects the public and private health sectors into a one-nation, one-system.
- PMJAY is technology-driven, paperless and cashless.
- There is no provision for reimbursement or co-payment.
- Most claim settlements are timely, intense efforts are being made for further improvements in partnership with the states.
- It has a pan India network of more than 29,000 empanelled hospitals of which 13,000 are in the private sector.
- Close to 25,000 of these hospitals are in Tier-2 and Tier-3 cities.
- About 57% of hospital admissions are in the private sector, indicating the significant participation of this sector.
Recent Inclusions in the PMJAY
- In the interim budget, the government extended the scheme to approximately 37 lakh families of ASHA and Anganwadi workers and helpers.
- PMJAY’s coverage is extended to all citizens aged 70 and above, regardless of their socioeconomic status.
Significance of PMJAY for the Elderly
- This will benefit 4.5 crore families and about 6 crore senior citizens.
- Hospitalisation rate for the group aged 70 and above exceeds 11%.
- 75% of the elderly have one or more chronic diseases.
- 40% have some form of disability.
- One in four suffers from multi-morbidity.
- 58% of the elderly population are women, with 54% being widows.
- Unlike many private insurance products for senior citizens, PMJAY does not exclude anyone because of a pre-existing illness, nor does it impose a year-long waiting period before the benefits are allowed.
- It will empower the elderly to lead healthy and dignified lives.
Impact of PMJAY
- PMJAY has significantly impacted service delivery in public sector hospitals across many states.
- The hospitals have utilised funds reimbursed under the scheme to enhance their amenities and infrastructure.
- With an increasing pace of coverage and reach, PMJAY has the potential to spur the growth of private hospitals in Tier 2 and 3 cities by creating a market where there was previously unmet demand due to a lack of paying capacity.
- Bottom 50% of India’s population has become significantly less vulnerable to medical expenditure-related shocks in the past 10 years and this trend is closely associated with PMJAY.
Conclusion: PMJAY is poised to play a pivotal role in building a Viksit Bharat as health is the very foundation of well-being, national productivity and prosperity.