Ayushman Bharat Pradhan Mantri Jan Arogya Yojana ( or PM-JAY'';'' also referred to as Ayushman Bharat National Health Protection Scheme or NHPS) is a national public health insurance fund of the
Government of India
The Government of India ( ISO: ; often abbreviated as GoI), known as the Union Government or Central Government but often simply as the Centre, is the national government of the Republic of India, a federal democracy located in South Asia, ...
that aims to provide free access to health insurance coverage for low income earners in the country. Roughly, the bottom 50% of the country qualifies for this scheme. People using the program access their own
primary care
Primary care is the day-to-day healthcare given by a health care provider. Typically this provider acts as the first contact and principal point of continuing care for patients within a healthcare system, and coordinates other specialist care ...
services from a family doctor. When anyone needs additional care, then PM-JAY provides free
secondary health care for those needing specialist treatment and
tertiary health care for those requiring hospitalization.
![Urban Primary Health Centre Ayushman Bharat Bidipeth Nagpur](https://upload.wikimedia.org/wikipedia/commons/1/16/Urban_Primary_Health_Centre_Ayushman_Bharat_Bidipeth_Nagpur.jpg)
The programme is part of the Indian government's
National Health Policy The central government of India periodically publishes a National Health Policy (NHP) to guide future health programs.
In 1979 the '' Journal of the Indian Medical Association'' published a review of the policy.
There has been 3 NHPs by Government ...
and is
means-tested. It was launched in September 2018 by the
Ministry of Health and Family Welfare
The Ministry of Health and Family Welfare is an Indian government ministry charged with health policy in India. It is also responsible for all government programs relating to family planning in India.
The Minister of Health and Family Welfare ...
. That ministry later established the
National Health Authority as an organization to administer the program. It is a centrally sponsored scheme and is jointly funded by both the union government and the states. By offering services to 50 crore (500 million) people it is the world's largest government sponsored healthcare program. The program is a
means-tested as its users are people with low
income in India
Income in India discusses the financial state in India. With rising economic growth and prosperity, India’s income is also rising rapidly. As an overview, India's per capita ''net national income'' or NNI was around 135 thousand rupees in 202 ...
.
History
In 2017 an Indian version of the
Global Burden of Disease Study reported major diseases and risk factors from 1990 to 2016 for every state in India. This study brought a lot of interest in government health policy because it identified major health challenges which the government could address. In 2018 the Indian government described that every year, more than six crores Indians were pushed into poverty because of out of pocket medical expenses. Despite various available regional and national programs for
healthcare in India
India has a multi-payer universal health care model that is paid for by a combination of public and private health insurance funds along with the element of almost entirely tax-funded public hospitals. The public hospital system is essential ...
, there was much more to be done. The Indian government first announced the Ayushman Bharat Yojana as a
universal health care
Universal health care (also called universal health coverage, universal coverage, or universal care) is a health care system in which all residents of a particular country or region are assured access to health care. It is generally organized ar ...
plan in February 2018 in the
2018 Union budget of India. The
Union Council of Ministers
The Union Council of Ministers Article 58 of the ''Constitution of India'' is the principal executive organ of the Government of India, which is responsible for being the senior decision making body of the executive branch. It is chaired by t ...
approved it in March. In his 2018
Independence Day
An independence day is an annual event commemorating the anniversary of a nation's independence or statehood, usually after ceasing to be a group or part of another nation or state, or more rarely after the end of a military occupation. Many ...
speech Prime Minister
Narendra Modi
Narendra Damodardas Modi (; born 17 September 1950) is an Indian politician serving as the 14th and current Prime Minister of India since 2014. Modi was the Chief Minister of Gujarat from 2001 to 2014 and is the Member of Parliament from ...
announced that India would have a major national health program later that year on 25 September, also commemorating the birthday of Pandit
Deendayal Upadhyaya
Pandit Deendayal Upadhyaya (25 September 1916 – 11 February 1968) was an Indian politician, proponent of integral humanism ideology and leader of the political party Bharatiya Jana Sangh (BJS), the forerunner of Bharatiya Janata Party (BJP) ...
.
![Stamp of India - 2019 - Colnect 926026 - 1st Anniversary Pradhan Mantri Jan Aarogya Yojana](https://upload.wikimedia.org/wikipedia/commons/f/f6/Stamp_of_India_-_2019_-_Colnect_926026_-_1st_Anniversary_Pradhan_Mantri_Jan_Aarogya_Yojana.jpeg)
In June 2018 the applications opened for hospitals through an "empanelment process". In July 2018, the Ayushman Bharat Yojana recommended that people access benefits through
Aadhaar
Aadhaar ( hi, आधार, ādhār, lit=base, foundation, bn, আধার) is a 12-digit unique identity number that can be obtained voluntarily by the citizens of India and resident foreign nationals who have spent over 182 days in twelve ...
, but also said that there was a process for people to access without that identity card. AB PM-JAY was first launched on 23 September 2018 at
Ranchi
Ranchi (, ) is the capital of the Indian state of Jharkhand. Ranchi was the centre of the Jharkhand movement, which called for a separate state for the tribal regions of South Bihar, northern Odisha, western West Bengal and the eastern area o ...
,
Jharkhand
Jharkhand (; ; ) is a state in eastern India. The state shares its border with the states of West Bengal to the east, Chhattisgarh to the west, Uttar Pradesh to the northwest, Bihar to the north and Odisha to the south. It has an area of . I ...
. By 26 December 2020 the scheme was extended to the Union Territories of Jammu Kashmir and Ladakh. The program has been called "ambitious".
Features
![Healthcare centre near Mahua](https://upload.wikimedia.org/wikipedia/commons/1/1d/Healthcare_centre_near_Mahua.jpg)
Features of PM-JAY include the following— providing health coverage for 10 crores households or 50 crores Indians; providing a cover of per family per year for medical treatment in empaneled hospitals, both public and private; offering
cashless payment
In economics, cash is money in the physical form of currency, such as banknotes and coins.
In bookkeeping and financial accounting, cash is current assets comprising currency or currency equivalents that can be accessed immediately or near-immed ...
and
paperless
A paperless office (or paper-free office) is a work environment in which the use of paper is eliminated or greatly reduced. This is done by converting documents and other papers into digital form, a process known as digitization. Proponents claim t ...
recordkeeping through the hospital or doctor's office; using criteria from the
Socio Economic and Caste Census 2011 to determine eligibility for benefits; no restriction on family size, age or gender; all previous medical conditions are covered under the scheme; it covers 3 days of pre-hospitalisation and 15 days of post-hospitalisation, including diagnostic care and expenses on medicines; the scheme is portable and a beneficiary can avail medical treatment at any PM-JAY empanelled hospital outside their state and anywhere in the country; providing access to free
COVID-19 testing
COVID-19 testing involves analyzing samples to assess the current or past presence of SARS-CoV-2. The two main types of tests detect either the presence of the virus or antibodies produced in response to infection. Molecular tests for viral ...
.
Implementation
Reach
Participation by states and union territories
India's
28 states and 8 union territories each make their own choice about whether to participate in Ayushman Bharat Yojana. In February 2018 when the program was announced 20 states committed to join. In September 2018 shortly after launch some states and territories declined to participate in the program. Maharashtra and Tamil Nadu initially declined to join because they each had their own state healthcare programmes.
Those programs,
Mahatma Jyotiba Phule Jan Arogya Yojana and the programme for Tamil Nadu, were already functioning well. These states later both joined Ayushman Bharat Yojana with special exceptions to make it part of their existing infrastructure.
In a similar way, Kerala, despite having its own health program agreed to begin using Ayushman Bharat Yogana from November 2019. West Bengal initially joined the program but then opted out in favor of establishing their own regional health programme. Telangana did the same. By January 2020 Odisha had not joined the scheme.
In March 2020 Delhi announced that it would join the program.
Participation by local people
In May 2020 Prime Minister
Narendra Modi
Narendra Damodardas Modi (; born 17 September 1950) is an Indian politician serving as the 14th and current Prime Minister of India since 2014. Modi was the Chief Minister of Gujarat from 2001 to 2014 and is the Member of Parliament from ...
said in his radio show ''
Mann Ki Baat
''Mann Ki Baat'' (, ) is an Indian radio programme hosted by Prime Minister Narendra Modi in which he addresses the people of the nation on All India Radio, DD National and DD News. Since the first show on 3 October 2014, there have been 97 epi ...
'' that the Ayushman Bharat scheme had recently benefited more than one crore people. By May 2020, the scheme had provided more than 1 crore treatments with a value of crore. The number of public and private hospitals empanelled nationwide stands at 24,432. The Ayushman Bharat Yojana programme announced a special collaboration with the
Employees' State Insurance
Employees' State Insurance Corporation (abbreviated as ESIC) is one of the two main statutory social security bodies under the ownership of Ministry of Labour and Employment, Government of India, the other being the Employees' Provident Fund ...
programme in November 2019. From June 2020, the program had entered a pilot to cover 120,000 workers with that insurance at 15 hospitals.
Challenges
When Ayushman Bharat Yojana began there were questions of how to reconcile its plans with other existing health development recommendations, such as from
NITI Aayog
The NITI Aayog (; abbreviation for National Institution for Transforming India) serves as the apex public policy think tank of the Government of India, and the nodal agency tasked with catalyzing economic development, and fostering cooperative ...
.
A major challenge of implementing a national health care scheme would be starting with infrastructure in need of development to be part of a modern national system.
While Ayushman Bharat Yojana seeks to provide excellent healthcare, India still has some basic healthcare challenges including relatively few doctors, more cases of infectious disease, and a national budget with a comparatively low central government investment in health care. Some of the problems lay outside the Health Ministry such as urban development or transport. While many government hospitals have joined the program, many private corporate hospitals have not. The private hospitals report that they would be unable to offer their special services at the government low price, even with a government subsidy.
There has been misuse of the Ayushman Bharat scheme by private hospitals through submission of fake medical bills. Under the Scheme, surgeries have been claimed to be performed on persons who had been discharged long ago and dialysis has been shown as performed at hospitals not having kidney transplant facility. There are at least 697 fake cases in
Uttarakhand
Uttarakhand ( , or ; , ), also known as Uttaranchal ( ; the official name until 2007), is a state in the northern part of India. It is often referred to as the "Devbhumi" (literally 'Land of the Gods') due to its religious significance and ...
State alone, where fine of has been imposed on hospitals for frauds under the Scheme. Initial analysis of high-value claims under PMJAY has revealed that a relatively small number of districts and hospitals account for a high number of these, and some hint of an anti-women bias, with male patients getting more coverage. Despite all efforts to curb foul-play, the risk of unscrupulous private entities profiteering from gaming the system is clearly present in AB-PMJAY.
References
Further consideration
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External links
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UHI (Unified Health Interface) scheme of Ayushman Bharat Yojna
{{DEFAULTSORT:Yojana, Ayushman Bharat
Health programmes in India
Publicly funded health care
2018 introductions
Social security in India
2018 establishments in India
Government schemes in India