PMJAY (Pradhan Mantri Jan Arogya Yojana), also known as Ayushman Bharat, is a government-run healthcare scheme in India aimed at providing health coverage for the country’s most vulnerable populations. The scheme, launched in September 2018, aims to provide free health coverage of up to INR 5 lakhs per family per year for secondary and tertiary care hospitalization expenses. The primary objective of PMJAY is to achieve universal health coverage (UHC) by supporting the underserved communities who face challenges in accessing quality healthcare in India.
PMJAY Decoded
PMJAY is a family-centric approach to UHC, which aims to deliver a pro-poor, pro-rural, and inclusive healthcare system in India. The scheme is designed to cover over 100 million families, which roughly translates to 40% of the total population. Instead of focusing on individual health coverage, PMJAY covers the entire family, including the head of the household, spouses, and up to five dependent children aged 25 years or younger.
The scheme has several key features, including cashless and paperless services, portability, and a large network of empaneled hospitals. The scheme is free of cost and is available to all eligible beneficiaries without any discrimination based on gender, religion, caste, or economic status. Beneficiaries are identified through the Socio-Economic Caste Census (SECC) database, and the implementation of the scheme is done through a partnership between the central and state governments.
Family Health Insurance
Family health insurance has been a growing necessity in India, where healthcare costs are rising rapidly. With PMJAY, the government is trying to provide health coverage to families living below the poverty line, along with those working in the unorganized sector. This move is significant since the majority of families in India are joint families, and individual health coverage cannot meet their healthcare needs comprehensively.
PMJAY provides an annual coverage of up to INR 5 Lakhs ($6,677) per family for secondary and tertiary care hospitalization expenses. It includes medical and surgical procedures, diagnostics, and medications, making it one of the most comprehensive health coverage schemes in the world. The enrolment for PMJAY is automatic for eligible beneficiaries, and the card provided under the scheme can be used across India in any of the empaneled hospitals. However, it is important to note that the scheme does not cover outpatient services, dental procedures, domiciliary hospitalization, and cosmetic surgeries.
The Benefits of PMJAY
PMJAY is a game-changer in the Indian healthcare sector, as it helps to address multiple issues that have long plagued the health system. Here are some of the benefits of the scheme:
- Universal Health Coverage: PMJAY aims to achieve UHC in India by providing health coverage to financially vulnerable families who would otherwise not have access to quality healthcare.
- Affordable Healthcare: PMJAY covers the entire family, providing comprehensive cover for secondary and tertiary care hospitalization expenses, and making healthcare affordable for families living below the poverty line.
- No Discrimination: PMJAY is free of cost and available to all eligible beneficiaries without any discrimination based on gender, religion, caste, or economic status.
- Portability: PMJAY covers beneficiaries across India and can be used at any of the empaneled hospitals in the country. This feature allows beneficiaries to have access to quality healthcare even when they travel outside their home state.
- Paperless and Cashless: PMJAY is a paperless and cashless scheme, allowing beneficiaries to avail of medical services without worrying about the financial burden that comes with hospitalization.
Challenges in Implementation
While PMJAY is a significant step in the right direction, there are several challenges in its implementation. Here are some of the issues that need to be addressed:
- Empanelment of Hospitals: PMJAY empanels public and private hospitals across the country to ensure that beneficiaries have access to quality healthcare. However, the process of empanelment is slow and requires multiple checks, which leads to delays in the implementation of the scheme.
- Lack of Awareness: Many eligible beneficiaries are unaware of the scheme and how to avail of its benefits. The government needs to invest in awareness campaigns to ensure that beneficiaries are informed about the scheme and how to enroll.
- Verification of Beneficiaries: PMJAY uses the SECC database to identify eligible beneficiaries. However, the database is outdated and needs to be updated regularly to ensure that the scheme reaches the intended beneficiaries.
- Limited Coverage: PMJAY does not cover outpatient services, dental procedures, domiciliary hospitalization, and cosmetic surgeries. The government needs to consider expanding the scope of the scheme to include some of these services that are essential to a comprehensive healthcare system.
Conclusion
PMJAY is a family-centric approach to UHC, aimed at providing comprehensive health coverage to financially vulnerable families in India. Despite the challenges in its implementation, the scheme has the potential to transform the Indian healthcare system and achieve UHC in the country. The scheme is a step towards inclusivity, access, and affordability in healthcare. As we move towards 2030, the government must continue to invest in healthcare and ensure that PMJAY reaches its intended beneficiaries, as it is an essential component of the health and well-being of families and communities in India.
