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One year of Ayushman Bharat Pradhan Mantri Jan Arogya Yojana: 50 lakh hospital treatments with an eye towards universal health coverage

21 Oct 2019

Free secondary and tertiary treatment worth nearly Rs. 7,996 crores availed. Gujarat, Tamil Nadu, Chhattisgarh, Kerala and Andhra Pradesh emerge as the top performing States

 

More than half a crore treatments have been availed by poor and vulnerable Indians through Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (PM-JAY), the flagship scheme of the Government of India in its first one year of operation.

PM-JAY is the world’s largest fully Government funded health insurance, which was launched by Hon’ble Prime Minister Shri Narendra Modi on September 23, 2018. It provides a cover of up to Rs. 5 lakhs per family per year, for secondary and tertiary care hospitalization to over 10.74 crore vulnerable entitled families (more than 50 crore beneficiaries). PM-JAY provides cashless and paperless access to services for the beneficiary at the point of service.

The aim of PM-JAY is to provide financial risk protection to more than 50 crore poor and vulnerable Indians across the country by assuring them inpatient care for a range of serious illnesses, treatment for which typically pushes an estimated 6 crore families into poverty  each year because of catastrophic expenditure on healthcare.

Ayushman Bharat PM-JAY, at the national level, is managed and implemented by the National Health Authority. Headed by a full-time CEO, NHA is governed by a Governing Board chaired by the Hon. Union Minister of Health & Family Welfare and has 11 members. Inter-alia, its functions include, formulation of policies of PM-JAY development of operational guidelines, implementation mechanisms, coordination with state governments, monitoring and oversight, among others.

Since its inception, PM-JAY has shown strong acceptability across the country. So far, the scheme is being implemented in 32 States and Union Territories wherein more than 50 lakh free treatments have been provided. At the same time, PM-JAY, in the truest essence, is a partnership of public and private sector health systems. To date, more than 18,500 hospitals have been empanelled across India. In the first year, 53% of the empanelled hospitals are private, especially multi-specialty hospitals. Through the network of these empanelled hospitals, 9 treatments are done in every minute under PM-JAY. Further, around 51,000 portability cases have been recorded wherein migrant and travelling Indians have got their treatment outside their states.

These treatments worth around Rs. 8,000 crores have been carried out in just over one year, resulting in savings of nearly Rs. 16,000 crore to the beneficiary families. More than 60% of the amount spent has been on tertiary care. Cardiology, Orthopaedics, Radiation Oncology, Cardio-thoracic and Vascular Surgery, and Urology have emerged as the top tertiary specialities.

PM-JAY has made a good start and there is a long journey ahead. There are several areas of focus to improve the access, quality and affordability of care offered through PM-JAY. A few key areas of focus comprise extensive building of scheme awareness, establishing convergence of existing State schemes with PM-JAY, strengthening the existing IT and anti-fraud infrastructure and increasing empanelment of tertiary hospitals. Further, developing continuum of care framework for linkages of PM-JAY with primary care, and ensuring adoption of quality framework by the empanelled hospitals is also critical to the long-term success of PM-JAY.

This is just the beginning for this path-breaking scheme. We are grateful to the Hon’ble Prime Minister for his visionary leadership and constant guidance and support. The successful implementation of this scheme will help us take forward Pandit Deen Dayal Upadhyay’s vision of “Antyodaya” – the upliftment of the last man standing in the queue, such that the deprived man gets all benefits of development happening in the country.

Finally, as the scheme grows, we will continue to strive for reducing catastrophic out-of-pocket health expenditure, improving access to quality health care and meeting the unmet need of the population for hospitalization to move towards the vision of an ‘Ayushman Bharat’ and lead the way for achieving Universal Health Coverage.

PROGRESS OF PM-JAY (as on 17/10/2019)
E-Cards Issued = more than 10.9 crore
Beneficiaries Admitted in Hospital = More than 50 lakh
Amount Authorized for Admissions = More than 8000 Cr
Hospitals Empanelled = 18,552



(The author is Dr. Indu Bhusan, CEO, National Health Authority, Government of India. Views expressed are personal.)

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