About the scheme
- It is an umbrella of two major health initiatives, namely Health and Wellness Centres and Pradhan Mantri Jan Arogya Yojana (PM-JAY).
Health and Wellness Centres
- Under this 1.5 lakh existing Sub Health Centres (SHC), Primary Health Centres (PHC) and Urban Primary Health Centres (UPHC) to be transformed as Health Wellness Centres (HWC) by 2022.
- These centres will deliver Comprehensive Primary Health Care that is universal and free to users, with a focus on wellness and the delivery of an expanded range of services closer to the community.
- HWC are envisaged to deliver expanded range services that go beyond Maternal and child health care services to include care for non-communicable diseases, palliative and rehabilitative care, Oral, Eye and ENT care, mental health and first level care for emergencies and trauma, including free essential drugs and diagnostic services.
Pradhan Mantri Jan Arogya Yojana
- It is one significant step towards achievement of Universal Health Coverage (UHC) and Sustainable Development Goal – 3 (SDG3: “Ensure healthy lives and promote well-being for all at all ages”).
- AB-PMJAY will provide financial protection to 10.74 crore poor, deprived rural families and identified occupational categories of urban workers’ families as per the latest Socio-Economic Caste Census (SECC) data (approx. 50 crore beneficiaries). It will offer a benefit cover of Rs. 500,000 per family per year.
- This cover will take care of almost all secondary care and most of tertiary care procedures.
- To ensure that nobody is left out (especially women, children and elderly) there will be no cap on family size and age in the scheme.
- The benefit cover will also include pre and post-hospitalisation expenses.
- A defined transport allowance per hospitalization will also be paid to the beneficiary.
- Benefits of the scheme are portable across the country and a beneficiary covered under the scheme will be allowed to take cashless benefits from any public/private empanelled hospitals across the country.
- At the national level to manage, a National Health Authority has been set up. It will be chaired by the Minister of Health & Family Welfare which will enable the decision making at a faster pace, required for smooth implementation of the scheme.
- States/ UTs are advised to implement the scheme by a dedicated entity called State Health Agency (SHA).
Why in News?
- Data from a survey released by the National Health Agency shows that private hospitals account for 63% for all PMJAY claims and 75% of the total claim value.
- The agency’s survey also found that over 72% of private empanelled hospitals are located in just seven states: Uttar Pradesh, Rajasthan, Tamil Nadu, Gujarat, Maharashtra, Punjab and Karnataka.
- Medical audits have also revealed that private hospitals are more likely to indulge in fraud and abuse than public hospitals and more likely to discharge patients early post-surgery to cut costs.