EXPANSION OF AYUSHMAN BHARAT PM-JAY

Source: TimesofIndia

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Context

The Union government has approved health coverage to everyone who is 70 and above under the national insurance scheme Ayushman Bharat (AB).

Key decisions

• All senior citizens of the age 70 years and above irrespective of their socio- economic status would be eligible to avail the benefits of AB Pradhan Mantri Jan Arogya Yojana (PM-JAY).
• The eligible senior citizens would be issued a new distinct card under AB PM-JAY.
• The scheme will benefit 4.5 crore families with six crore senior citizens. 
• Senior citizens above 70 who are already getting benefits of other public health insurance schemes such as Central Government Health Scheme (CGHS), Ex-Servicemen Contributory Health Scheme (ECHS), and Ayushman Central Armed Police Force (CAPF) may either choose their existing scheme or opt for AB PMJAY.
• Senior citizens of 70 years and above who are under private health insurance policies or Employees' State Insurance Scheme will be eligible to avail benefits under AB PM-JAY.

About Ayushman Bharat

• It is a flagship healthcare initiative launched by the Government of India under the National Health Policy (NHP) 2017to achieve the goal of Universal Health Coverage (UHC).
• The scheme was introduced to align with the Sustainable Development Goals (SDGs), focusing on the principle of "leaving no one behind."
• It is designed to provide comprehensive healthcare services covering preventive, promotive, and curative careat all levels, ensuring affordable and accessible healthcare for all.
• Ayushman Bharat has two major components:
• Health and Wellness Centers (HWCs)
• Pradhan Mantri Jan Arogya Yojana (PM-JAY)

HWCs

• In February 2018, the Government announced the creation of 1,50,000 Health and Wellness Centers (HWCs)by transforming existing Sub-Centers (SCs) and Primary Health Centers (PHCs).
• These centers aim to deliver Comprehensive Primary Health Care (CPHC), making healthcare more accessible, especially to remote areas, and shifting the focus from treatment to health promotion and disease prevention.
• HWCs deliver an extended range of healthcare services, including maternal and child health, non-communicable diseases, and essential drugs and diagnostic services.

Pradhan Mantri Jan Arogya Yojana (PM-JAY)

Launched on September 23, 2018, in Ranchi, Jharkhand, by Prime Minister, PM-JAY is the world’s largest health assurance scheme.

Key Features

• Coverage: ₹5 lakh per family per year for secondary and tertiary care hospitalization in empaneled public and private hospitals.
• The scheme offers a family floatersystem, which allows a family to use the entire ₹5 lakh coverage for any family member.
• Beneficiaries are selected based on the Socio-Economic Caste Census (SECC) 2011, covering households with deprivation criteria.
• The scheme offers cashless and paperless accessto medical services at empaneled hospitals across the country.
• Unlike earlier health schemes, PM-JAY has no restrictions on family size, age, or gender.
• The benefits are portable across India, meaning eligible individuals can avail of services from any empaneled hospital.
• The scheme subsumes the Rashtriya Swasthya Bima Yojana (RSBY), integrating previous beneficiaries under its umbrella.
• Coverage includes pre-existing conditionsfrom day one.

Coverage

• Medical examination, treatment, and consultations
• Pre-hospitalization (up to 3 days)
• Post-hospitalization (up to 15 days)
• Non-intensive and intensive care services
• Diagnostic and laboratory services
• Implants, surgeries, and follow-up care

Working

• The scheme has covered 7.37 crore hospital admissions including 49 per cent women beneficiaries.
• The public has benefited to the extent of over ₹ 1 lakh crore under the scheme.
• Initially, 10.74 crore poor and vulnerable families comprising the bottom 40 per cent of India's population were covered under the scheme.
• Later, the government in January 2022 revised the beneficiary base under AB PM-JAY from 10.74 crore to 12 crore families considering India's decadal population growth of 11.7 per cent over 2011 population.
• The scheme was further expanded to cover 37 lakh ASHAs/AWWs/AWHs working across the country and their families for free healthcare benefits.

Read about the scheme in detail: https://www.iasgyan.in/daily-current-affairs/pm-jay-scheme

Sources:TimesofIndia