Figure 2: No Copyright Infringement Intended

In Context:

• The Pradhan Mantri Jan Arogya Yojana (PMJAY) provided a cushion to only 14.25 per cent of people hospitalized for the COVID19, between April 2020 and June 2021.

 About:

• The scheme was launched in September 2018 and recommended by the National Health Policy 2017, to achieve the vision of Universal Health Coverage (UHC).
• It is a Centrally Sponsored Scheme having a central sector component under Ayushman Bharat Mission
• PMJAY was earlier known as the National Health Protection Scheme (NHPS) before being rechristened.
• It subsumed the then existing Rashtriya Swasthya Bima Yojana (RSBY) which had been launched in 2008.

Key Features:

• It is the world`s largest health insurance/ assurance scheme fully financed by the government and the cost of implementation is shared between the Central and State Governments.
• It provides compensation of Rs 5 Lakbh per family per year for secondary and tertiary hospitalizations in public and private hospitals in India.
• There will be costs for diagnosis and medication from 3 days before admission to 15 days after admission.
• There are no restrictions on the number of family members, age or gender.
• All existing conditions will be covered from day one.

Eligibility:

• Households included are based on the deprivation and occupational standards of the Rural and Urban Socio-Economic Caste Census 2011 (SECC 2011).
• Therefore, the coverage mentioned in PMJAY also includes families that are covered by RSBY but not included in the SECC2011 database.
• Cover under PMJAY Insurance coverage includes all costs incurred for the following elements of treatment:
• Health check, treatment, advice Before hospitalization Medicines and medicines Non-intensive and intensive care services Diagnosis and laboratory tests Medical implant service (if needed) Benefits of accommodation.
• After Complications during treatment Follow-up care after hospitalization for up to 15 days

Goals:

• Focusing on the development of healthcare infrastructure, including pediatric care, and delivering measurable results, accelerate the preparation of healthcare systems for rapid response for early prevention, detection, and management.

 Success:

• It provides the point of service, the beneficiaries in the hospital, with cashless access to medical services.
• It aims to reduce the dire medical costs that drive nearly 6 billion Indians into poverty each year.
• success Over the last three years, the AB PMJAY program has reached several milestones in achieving its universal health goals.
• The program has expanded its reach to 33 states / regions in the Union, making the lives of beneficiaries easier while receiving treatment.
• Under the program, more than one crore treatment is available to beneficiaries.
• It has been shown to be a blessing to women. More than half of the total number of beneficiaries who receive benefits under this system are female.

 

Issues:

• PMJAY paid only 520,000 COVID 19 hospital stays This percentage is negligible, considering that the scheme is said to cover 165 million beneficiaries nationwide.
• State insurance did not cover all eligible groups and beneficiaries, insureds also had to fight pandemics themselves and raise large sums of money for treatment.
• Under PMJAY, beneficiaries can only access the list of affiliated private hospitals. This remains a big problem, especially in small towns and villages with few hospitals.
• PMJAY has excluded certain communities. For example, thousands of sex workers in Budhwar Peth Zone has been excluded.

 

Way Ahead:

• The government is revising the beneficiary identification system to make it easier and faster for program beneficiaries to register.
• The government is streamlining packaging, tariffs, and treatment protocols to meet the needs of the medical This makes the package more viable for dedicated healthcare providers and makes it more attractive for new healthcare providers to join the PMJAY ecosystem.
• Governments are also making IT platforms more robust, streamlining and automating billing decision logs, and speeding bill settlement.
• PMJAY aims to build a health highway in line with the National Digital Health Mission (also a flagship program run by NHA) to provide global health continuity to countless families across the country.