AB PM-JAY has facilitated approximately 2.2 crore hospital admissions worth ₹26,450 crore through a network of nearly 24,000 hospitals across the country. The scheme has emerged as the world’s largest government funded healthcare scheme that aims to cover 10.74 crore families or 53 crore individuals, identified from the Socio-Economic Caste Census database of 2011. It is pertinent to note that the 33 States/UTs implementing AB PM-JAY have further expanded the beneficiary database to 13.44 crore families (65 crore individuals).

Features

• Offers a 5 lakh sum insured per family for both secondary and tertiary care. This is a no-cost programme for the recipients.
• It’s an entitlement-based programme that focuses on the people identified by the latest Socio-Economic Caste Census (SECC) data as beneficiaries.
• Individuals can go to any empanelled hospital that accepts cashless payments to make a payment.
• The beneficiary is considered insured once the database has recognised him or her.
• The expense of insurance is split around 60:40 between the centre and the state.
• Under PMJAY, empanelled hospitals agree to the packaged prices—there are over 1,400 packaged rates for various medical treatments.

Analysis

• The scheme has essayed a crucial role in enlisting the support of the healthcare ecosystem to foster improved access to quality healthcare.
• This is evident from the fact that nearly 60 per cent of all hospitalisations have come from the private sector. Furthermore, perhaps for the first time, a healthcare scheme has put gender equality at the forefront.
• Approximately 50 per cent of Ayushman card recipients are women and over 47 per cent of the authorised hospital admissions have also been availed by women.
• With a vast network of 24,000 empanelled healthcare providers across India, AB PM-JAY is implemented through a robust data-driven technology framework.
• The PM-JAY IT system has the capacity to handle more than 30 beneficiary verification transactions per second. Additionally, 28 hospital admissions are raised on the PM-JAY transaction management system per minute

Challenges

• Because health is a state responsibility and states are projected to contribute 40% of the scheme’s funds, it would be vital to streamline and harmonise existing state health insurance plans to PMJAY.
• Costs are a point of contention between providers and the government, with many for-profit hospitals dismissing the government’s ideas as unworkable.
• Private Sector Accountability: The public sector’s lack of health-care capacity necessitates the formation of crucial alliances and coalitions with private-sector providers.
• Only if the providers are held accountable for their services can the provision of services be ensured in such circumstances.
• The National Health Policy of 2017 advocated paying for “strategic purchasing” services from secondary and tertiary hospitals. To avoid unnecessary treatment, the contracts with the healthcare professionals who will receive the financial reimbursement package should clearly state that full adherence to recognised rules and standard treatment protocols will be required.

Way forward

• The first objective should be to develop a strategy for universal health coverage based on constant infrastructure upgrades in the public sector.
• To reduce the illness burden, all necessary inter-sectoral actions linking health and development should be brought together to provide access to clean drinking water, sanitation, garbage disposal, waste management, food security, nutrition, and vector control.
• Incorporating the Swachh Bharat initiative into Ayushman Bharat could be a first step in that direction.
• District hospitals will be upgraded to government medical colleges and teaching hospitals, which would improve district capacity.
• By requiring service providers to adopt strong governance practises, they may maintain cost and quality responsibility on their end.
• Using technology and innovation effectively can help to reduce the overall cost of healthcare. Mobile apps driven by AI can deliver high-quality, low-cost, patient-centric smart wellness solutions. The Ayushman Bharat IT infrastructure, which is scalable and interoperable, is a step in the right direction.

AB PM-JAY has made access to advanced healthcare a reality for countless number of marginalised Indians. As we look to enter a post-pandemic world, AB PM-JAY aspires to build a healthcare super-highway in consonance with the National Digital Health Mission (a flagship scheme also driven by the NHA) to offer a holistic continuum of healthcare for innumerable families in the country.

How to structure:

• Give an introduction of PM- JAY
• Mention the features of this scheme
• Now, explain how it is trying to bring equitable access to healthcare, equity here means that services are accessible on the basis of need rather than on geographical location or ability to pay.
• Mention the issues/ drawbacks of PM-JAY
• Conclude

Reference:

1. https://www.thehindubusinessline.com/opinion/pm-jay-a-holistic-continuum-of-healthcare/article36615444.ece