Why Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (PM-JAY) in news?

Minister of State for health S.P. Singh Baghel told about the target achievement of Ayushman Bharat-Pradhan Mantri Jan Arogya Yojna which has resulted in huge out-of pocket expenditure savings related to hospitalisations for the targeted beneficiaries.

Minister of State for health stated a total of 3.14 crore beneficiaries are benefitted under the Ayushman Bharat-Pradhan Mantri Jan Arogya Yojna during the last two years.

About the Ayushman Bharat-PM Jan Arogya Yojna

PM-JAY is the world’s largest health insurance/ assurance scheme fully financed by the government.

This scheme was launched in February 2018 with the aim to provide free medical treatment of up to Rs.5 lakh per family for secondary care (which doesn’t require super specialist) as well as for tertiary care (which requires super specialist).

Under PM-JAY, cashless and paperless access to services are provided to the beneficiaries at the point of service, that is hospital.

Health Benefit packages under the PM-JAY covers surgery, medical and day care treatment, cost of medicines and diagnosis.

Agency responsible

An autonomous entity has been constituted under the Society Registration Act, 1860 namely National Health Authority (NHA), for the effective implementation of PM-JAY in alliance with the state governments.

The State Health Authority (SHA) is the apex body of the state government responsible for the implementation of PM-JAY in the state.

Beneficiaries

Under this scheme the beneficiaries are identified by the latest data of Socio-Economic Caste Census (SECC). Once the identification is done, the beneficiaries are insured and walk into any empaneled hospital.

Funding

The funding of this scheme for all the states and UTS with their own legislation is in the ratio of 60:40.

The fund sharing ratio for Northeast states, Jammu and Kashmir, Himachal Pradesh and Uttarakhand is 90:10.

All the UTs without any legislation are 100% central funding.

Budget allocation for 2023

The PM-JAY has received an allocation of Rs.7,200 crore under the Union Budget 2023.

Challenges

• Lack of cooperation of states
• Burden of costs
• Inadequate health capacities
• The National Health Policy 2017 proposed “strategic purchasing” of services from secondary and tertiary hospitals for a fee.

Achievements

According to the data about 3.14 crore beneficiaries are benefitted under the scheme during the last two years. This scheme played a key role during the Covid-19 pandemic which ensured that a PM-JAY eligible migrant worker can access the scheme’s services across the country, irrespective of their residence.