Syllabus: GS2/Health
Context
- Recently, Odisha has officially joined the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB PM-JAY).
- The scheme will be implemented in convergence with Odisha’s existing Gopabandhu Jan Arogya Yojana (GJAY).
Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB PM-JAY)
- About: It is a flagship health insurance scheme (Centrally Sponsored Scheme) that was launched in 2018. It aims to provide accessible and affordable healthcare to the economically disadvantaged sections of society.
- National Health Authority (NHA) is the implementing agency of the scheme under the MoH&FW.
- Objectives: To reduce the financial burden on poor and vulnerable groups arising out of catastrophic hospital episodes.
- To ensure access to quality health services.
- To provide a health cover of up to ₹5 lakh per family per year for secondary and tertiary care hospitalization.
- Key Features:
- Coverage: Over 10.74 crore poor and vulnerable families (approximately 50 crore beneficiaries) identified based on the Socio-Economic Caste Census (SECC) data.
- Cashless and Paperless: Beneficiaries can avail of cashless and paperless access to health services at the point of service in any empaneled hospital, both public and private, across India.
- Comprehensive Benefits: Covers pre- and post-hospitalization expenses, diagnostics, medicines, and nearly 1,400 medical procedures, including major surgeries.
- Funding Pattern: 60:40 cost-sharing between the Union Government and States.
- 90:10 for North Eastern States and Himalayan States (Himachal Pradesh, Uttarakhand, and Jammu & Kashmir (UT)).
- 100% central funding for Union Territories (UTs) without a legislature.
- Recent Developments: In 2024, the Union Cabinet approved the expansion of Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB PM-JAY) to cover all senior citizens aged 70 and above, irrespective of their income status.
- Benefits and Impact: Since its inception, AB PM-JAY has achieved:
- 8.19 crore hospital admissions, with ₹1.13 lakh crore spent on healthcare.
- Coverage for 45% of India’s population.
- Reduced out-of-pocket healthcare expenses for the poor.
- Increased access to both public and private healthcare facilities.
Why States are Reluctant to Join PM-JAY?
- Financial Concerns: States are worried about the financial burden of implementing the scheme. While the central government provides a significant portion of the funding, states still need to contribute, which can strain their budgets.
- Existing State Schemes: Some states/UT already have their own health insurance schemes that they believe are more tailored to their specific needs. For example: Delhi Arogya Kosh (DAK) scheme offering similar benefits.
- Administrative Challenges: Managing a large-scale scheme like PM-JAY requires robust administrative capacity.
- Political Differences: Political dynamics between state and central governments often influence decisions.
| Health in India – Health is a State Subject in Schedule VII in Indian Constitution, making healthcare delivery primarily the states’ responsibility. – It covers primary and secondary healthcare, public health initiatives, health infrastructure etc. – National Health Mission (NHM) is a flagship initiative that provides financial and technical assistance to states to strengthen their healthcare systems. Key components of NHM include: 1. NRHM: Focuses on rural healthcare. 2. NUHM: Addresses urban health challenges. 3. RMNCH+A: Provides healthcare across different life stages. Other Important Initiatives – Ayushman Bharat Digital Mission (ABDM): It aims to create a national digital health ecosystem that supports universal health coverage in an efficient, accessible, inclusive, affordable, timely, and safe manner. 1. It includes initiatives like the Ayushman Bharat Health Account (ABHA) number, which allows individuals to access and share their health records digitally. 2. Other components include the CoWIN app for COVID-19 vaccination, Aarogya Setu for contact tracing, and e-Sanjeevani for telemedicine services. – National Health Policy, 2017: It aims to achieve universal health coverage and deliver quality health care services to all at affordable costs. 1. It emphasizes preventive and promotive health care, strengthening the primary health care system, and ensuring access to essential medicines and technologies. |
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