Ayushman Bharat Pradhan Mantri Jan Arogya Yojana expanded UPSC

EXPANSION OF AYUSHMAN BHARAT PM-JAY

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Context

The Union government has approved health coverage to everyone who is 70 and above under the national insurance scheme Ayushman Bharat (AB).

Key decisions

All senior citizens of the age 70 years and above irrespective of their socio- economic status would be eligible to avail the benefits of AB Pradhan Mantri Jan Arogya Yojana (PM-JAY).
The eligible senior citizens would be issued a new distinct card under AB PM-JAY.
The scheme will benefit 4.5 crore families with six crore senior citizens.
Senior citizens above 70 who are already getting benefits of other public health insurance schemes such as Central Government Health Scheme (CGHS), Ex-Servicemen Contributory Health Scheme (ECHS), and Ayushman Central Armed Police Force (CAPF) may either choose their existing scheme or opt for AB PMJAY.
Senior citizens of 70 years and above who are under private health insurance policies or Employees' State Insurance Scheme will be eligible to avail benefits under AB PM-JAY.

About Ayushman Bharat

It is a flagship healthcare initiative launched by the Government of India under the National Health Policy (NHP) 2017to achieve the goal of Universal Health Coverage (UHC).
The scheme was introduced to align with the Sustainable Development Goals (SDGs), focusing on the principle of "leaving no one behind."
It is designed to provide comprehensive healthcare services covering preventive, promotive, and curative careat all levels, ensuring affordable and accessible healthcare for all.
Ayushman Bharat has two major components:
Health and Wellness Centers (HWCs)
Pradhan Mantri Jan Arogya Yojana (PM-JAY)

HWCs

In February 2018, the Government announced the creation of 1,50,000 Health and Wellness Centers (HWCs)by transforming existing Sub-Centers (SCs) and Primary Health Centers (PHCs).
These centers aim to deliver Comprehensive Primary Health Care (CPHC), making healthcare more accessible, especially to remote areas, and shifting the focus from treatment to health promotion and disease prevention.
HWCs deliver an extended range of healthcare services, including maternal and child health, non-communicable diseases, and essential drugs and diagnostic services.

Pradhan Mantri Jan Arogya Yojana (PM-JAY)

Launched on September 23, 2018, in Ranchi, Jharkhand, by Prime Minister, PM-JAY is the world’s largest health assurance scheme.

Key Features

Coverage: ₹5 lakh per family per year for secondary and tertiary care hospitalization in empaneled public and private hospitals.
The scheme offers a family floatersystem, which allows a family to use the entire ₹5 lakh coverage for any family member.
Beneficiaries are selected based on the Socio-Economic Caste Census (SECC) 2011, covering households with deprivation criteria.
The scheme offers cashless and paperless accessto medical services at empaneled hospitals across the country.
Unlike earlier health schemes, PM-JAY has no restrictions on family size, age, or gender.
The benefits are portable across India, meaning eligible individuals can avail of services from any empaneled hospital.
The scheme subsumes the Rashtriya Swasthya Bima Yojana (RSBY), integrating previous beneficiaries under its umbrella.
Coverage includes pre-existing conditionsfrom day one.

Coverage

Medical examination, treatment, and consultations
Pre-hospitalization (up to 3 days)
Post-hospitalization (up to 15 days)
Non-intensive and intensive care services
Diagnostic and laboratory services
Implants, surgeries, and follow-up care

Working

The scheme has covered 7.37 crore hospital admissions including 49 per cent women beneficiaries.
The public has benefited to the extent of over ₹ 1 lakh crore under the scheme.
Initially, 10.74 crore poor and vulnerable families comprising the bottom 40 per cent of India's population were covered under the scheme.
Later, the government in January 2022 revised the beneficiary base under AB PM-JAY from 10.74 crore to 12 crore families considering India's decadal population growth of 11.7 per cent over 2011 population.
The scheme was further expanded to cover 37 lakh ASHAs/AWWs/AWHs working across the country and their families for free healthcare benefits.

Read about the scheme in detail: https://www.iasgyan.in/daily-current-affairs/pm-jay-scheme

Sources:TimesofIndia

PRACTICE QUESTION

Q: Consider the following statements about Ayushman Bharat Digital Mission:

1.Private and public hospitals must adopt it.

2.As it aims to achieve universal health coverage, every citizen of India should be part of it ultimately.

Which of the above statements is/are correct?

a) 1 only

b) 2 only

c) Both 1 and 2

d) Neither 1 nor 2

Answer: d

Explanation:

1^st statement is incorrect: Participation of a healthcare facility or an institution in Ayushman Bharat Digital Mission (ABDM) is voluntary and shall be taken by the respective management (government or private management).

2^nd statement is incorrect: It is not mandatory for all citizens to get an Ayushman Bharat Health Account (ABHA) Number. Whoever wishes to participate in the Ayushman Bharat Digital Mission and wishes to have their records available digitally may create an ABHA Number.