CURRENT AFFAIRS

Description

Ayushman Bharat Pradhan Mantri Jan Arogya Yojana

Description

Read about the recent changes in the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB PM-JAY), how it provides financial protection for healthcare to millions of families in India. Also learn about its benefits, eligibility, and impact on the healthcare system.

Introduction

India’s healthcare system has faced numerous challenges over the years, primarily due to high medical costs and the inability of many people to access necessary treatments. In response, the government launched Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB PM-JAY), a flagship scheme designed to ensure healthcare access to the most vulnerable. This initiative is one of the largest healthcare programs globally, providing coverage to millions of families across India.

About Ayushman Bharat Pradhan Mantri Jan Arogya Yojana

AB PM-JAY is a government-sponsored health insurance scheme aimed at providing free healthcare to economically disadvantaged families. Launched in 2018, it ensures that millions of citizens receive financial assistance for hospitalization, ensuring they don’t bear the burden of medical expenses. The scheme is a step toward universal health coverage and aims to benefit nearly 50 crore individuals across the country.

Objective of the Scheme

•         The primary goal of AB PM-JAY is to provide financial protection to low-income families, particularly for secondary and tertiary medical treatments.
•          The scheme strives to improve health outcomes and reduce out-of-pocket expenses that often push people into poverty.

Key Features of AB PM-JAY

•          Health Coverage Amount

Under AB PM-JAY, eligible families receive a health cover of up to ₹5 lakh per year. This can be used for treatments in empaneled public and private hospitals across India.

•          Cashless Treatment

One of the significant features of the scheme is the provision of cashless treatment. Patients can avail of treatment at any empaneled hospital without worrying about upfront payments, as the government settles the bills directly with the hospital.

•          Paperless Registration

The entire process, from registration to treatment, is paperless. Beneficiaries only need to verify their identity and eligibility, making the process efficient and accessible for all.

•          Eligibility

AB PM-JAY targets the economically weaker sections of society. The eligibility is determined based on Socio-Economic Caste Census (SECC) data, which identifies families in need of financial support. Key beneficiaries include rural families with deprived living conditions and urban families employed in low-income occupations like street vending, construction, and domestic work.

How AB PM-JAY Works

Steps to Access the Scheme

1. Check Eligibility: The first step is to verify whether your family qualifies for AB PM-JAY benefits. This can be done online through the government portal or by visiting the nearest hospital or Common Service Center.
2. Registration and Verification: Once eligibility is confirmed, the family is registered, and the beneficiaries receive a health card, which they can use for hospital admissions.
3. Avail Treatment: At the time of hospitalization, beneficiaries need to show their health card, and all medical costs up to ₹5 lakh are covered by the scheme.

Public and Private Hospitals Empaneled

Both public and private hospitals have been empaneled under AB PM-JAY to ensure that beneficiaries can access quality treatment. Hospitals must meet specific criteria and quality standards to be part of the network, ensuring that patients receive high-quality care.

Diseases Covered Under AB PM-JAY

AB PM-JAY covers a wide range of diseases, including secondary and tertiary care procedures. This includes surgeries, critical treatments like cancer care, cardiovascular diseases, and major surgeries. Additionally, procedures related to maternity, pediatric care, and orthopedics are covered under the scheme.

Benefits of AB PM-JAY

•         Financial Protection for Families

The biggest benefit of the scheme is the financial protection it offers. By covering hospitalization expenses, families are protected from the devastating financial consequences of medical emergencies.

•         Improvement in Health Access and Outcomes

AB PM-JAY has improved access to healthcare for millions of people who would otherwise be unable to afford treatment. By ensuring timely care, the scheme has also helped in improving overall health outcomes.

Recent changes

1. Eligibility for All Senior Citizens (70 and Above)

Under the new approval, senior citizens who are 70 years old or older, irrespective of their socio-economic status, are now eligible for health coverage under the AB PM-JAY scheme. This ensures that a vulnerable section of society receives necessary health protection, removing any barriers related to income or financial background.

2. Additional Coverage for Families Already Enrolled

Senior citizens (70-plus) belonging to families that are already covered under the AB PM-JAY will receive an additional top-up health cover. They will get up to ₹5 lakh per year for their medical needs. Importantly, this coverage is exclusive to them and does not need to be shared with other family members under the age of 70.

3. Co-existence with Other Public Health Insurance Schemes

Senior citizens who are currently benefiting from other public health schemes such as the Central Government Health Scheme (CGHS), Ex-Servicemen Contributory Health Scheme (ECHS), and Ayushman Central Armed Police Force (CAPF) have the flexibility to either retain their existing coverage or switch to the AB PM-JAY. This provides greater choice and freedom for individuals to select the most suitable healthcare coverage for their needs.

4. Eligibility for Private Policyholders and ESI Beneficiaries

Individuals aged 70 and above who are already covered by private health insurance policies or the Employees' State Insurance Scheme (ESIS) are also eligible to avail of the benefits under the AB PM-JAY. This makes the scheme inclusive, extending its coverage to a wide range of citizens who may already be part of other insurance plans.

Conclusion

The implementation of AB PM-JAY has significantly impacted India's healthcare landscape. It has not only reduced out-of-pocket expenditure but also helped in reducing poverty caused by medical costs. Furthermore, the scheme has led to the empanelment of more hospitals and the improvement of healthcare infrastructure in rural areas.

Despite its success, AB PM-JAY faces several challenges. These include funding and sustainability concerns, particularly in maintaining such a large-scale program. Additionally, ensuring quality healthcare across all empaneled hospitals and improving healthcare infrastructure in remote regions remain pressing issues.

As the government continues to refine the scheme, potential improvements include expanding the coverage to include outpatient care and medicines. Efforts are also underway to ensure the program reaches every eligible family and increases awareness about the benefits it offers.