Pradhan Mantri Jan Arogya Yojana
Pradhan Mantri Jan Arogya Yojana (PM-JAY), also known as Ayushman Bharat Yojana, is a flagship health insurance scheme launched by the Government of India in September 2018. The scheme aims to provide free access to healthcare for the country’s vulnerable and economically disadvantaged population. PM-JAY is the world’s largest health insurance/assurance scheme fully financed by the government, providing a cover of ₹5 lakh (approximately $6,800) per family per year for secondary and tertiary care hospitalization.
Eligibility
The scheme is designed to cover over 10.74 crore (107.4 million) vulnerable and economically disadvantaged families, which constitute the bottom 40% of the Indian population. The beneficiaries are identified based on the Socio-Economic Caste Census (SECC) 2011 data. The scheme is cashless and paperless at the point of service, and beneficiaries can avail services at both public and empanelled private healthcare facilities.
Benefits
PM-JAY provides a comprehensive cover for secondary and tertiary care hospitalization, including but not limited to:
- Hospitalization expenses
- Day care surgeries
- Pre and post-hospitalization expenses
- Diagnostics and medicines
- Transportation costs
The scheme also covers pre-existing diseases from the first day of the policy. In addition, the scheme provides beneficiaries with access to a network of over 10,000 empanelled hospitals across the country.
Implementation
PM-JAY is implemented by the National Health Authority (NHA) under the Ministry of Health and Family Welfare, Government of India. The scheme is implemented in partnership with state governments, which are responsible for the identification of beneficiaries and the empanelment of hospitals. The scheme is funded through a combination of central and state government funds, with the central government providing 60% of the funding and the state governments providing the remaining 40%.
Impact
As of March 2023, over 3.65 crore (36.5 million) hospitalization cases have been authorized under the scheme, with an estimated worth of ₹45,294 crore (approximately $6.1 billion). The scheme has significantly improved access to healthcare for the country’s vulnerable and economically disadvantaged population, reducing out-of-pocket expenditure and providing financial protection against catastrophic health expenses.
Challenges
Despite its success, PM-JAY faces several challenges, including:
- Limited awareness among beneficiaries
- Inadequate infrastructure and human resources in public healthcare facilities
- Delays in the empanelment of hospitals and the settlement of claims
- Concerns about the quality of care provided under the scheme
Way Forward
To address these challenges and ensure the long-term sustainability of PM-JAY, the government is focusing on several key areas, including:
- Increasing awareness and enrollment of beneficiaries
- Strengthening public healthcare infrastructure and human resources
- Streamlining the empanelment and claims settlement processes
- Implementing quality assurance mechanisms and grievance redressal systems
Pradhan Mantri Jan Arogya Yojana (PM-JAY) has the potential to transform healthcare access and financial protection for India’s most vulnerable populations. While challenges remain, the scheme’s impact and potential cannot be overstated. As the scheme continues to evolve and expand, it is poised to play a crucial role in India’s journey towards universal health coverage and the achievement of the Sustainable Development Goals.
