Ayushman Bharat–PM Jan Arogya Yojana

History

• The Government of India is currently focusing largely on Reproductive, Maternal, New-born, Child and Adolescent Health (RMNCH+A) and communicable diseases.
• Families are forced to incur high out of pocket expenditure thereby leading to impoverishment and poverty.
• Health is an important cornerstone to the Government’s vision of development, ‘Swasth Bharat, Samriddha Bharat’ (Healthy India, Prosperous India).
• To fulfil the vision of Health for All and Universal Health Coverage, enshrined in the National Health Policy 2017, the Government conceived Áyushman Bharat’ (Healthy India), a pioneering initiative led by the Prime Minister.

Formation

• Ayushman Bharat Yojana or Pradhan Mantri Jan Arogya Yojana (PMJAY) or National Health Protection Scheme is a centrally sponsored scheme launched in 2018, under the Ayushman Bharat Mission of Ministry of Health and Family Welfare (MoHFW) for a New India -2022.
• Ayushman Bharat (AB) is an attempt to move from sectoral and segmented approach of health service delivery to a comprehensive need-based health care service.

• The scheme aims at making interventions in primary, secondary and tertiary care systems, covering both preventive and pro-motive health, to address healthcare holistically.
• It is an umbrella of two major health initiatives namely, Health and Wellness centres and National Health Protection Scheme (NHPS).
• The scheme is formed by subsuming multiple schemes including Rashtriya Swasthya Bima Yojana, Senior citizen health Insurance Scheme (SCHIS), etc.
• Further, the National Health Policy, 2017 has envisioned Health and Wellness Centres as the foundation of India’s health system which the scheme aims to establish.

Features

• The PM-JAY is one significant step towards achievement of Universal Health Coverage (UHC) and Sustainable Development Goal - 3 (SDG - 3).
• For focused approach and effective implementation of PM-JAY, an autonomous entity, the National Health Agency (NHA) was constituted.
• Established as a Society on 11th May 2018, the National Health Agency is registered under the Society Registration Act, 1860.

• The State Governments are similarly expected to set up State Health Agencies (SHA) to implement PM-JAY.
• The National Health Agency (NHA) will provide overall vision for design, implementation and management of Pradhan Mantri Jan Arogya Yojana (PM-JAY).

Health and Wellness Centres

• Under this 1.5 lakh existing sub centres will bring health care system closer to the homes of people in the form of Health and wellness centres.
• These centres will provide comprehensive health care, including for non-communicable diseases and maternal and child health services.

List of Services to be provided at Health & Wellness Centre

• Pregnancy care and maternal health services
• Neonatal and infant health services
• Child health
• Chronic communicable diseases
• Non-communicable diseases
• Management of mental illness
• Dental care
• Eye care
• Geriatric care Emergency medicine

National Health Protection Mission (AB-PMJAY)

Eligibility criteria

• The different eligibility categories in rural and urban areas are
  • families having only one room with kucha walls and kucha roof;
  • families having no adult member between age 16 to 59;
  • female headed households with no adult male member between age 16 to 59;
  • disabled member;
  • SC/ST households;
  • landless households deriving their income from manual casual labour,
  • Families in rural areas having any one of the following: households without shelter, destitute, living on alms, manual scavenger families, primitive tribal groups, released bonded labour.
  • In urban areas, 11 defined occupational categories are entitled under the scheme.
    • Rag picker.
    • Domestic worker.
    • Street vendor/ Cobbler/hawker / Other service provider working on streets.
    • Construction worker/ Plumber/ Mason/ Labour/ Painter/ Welder/ Security guard/ Coolie and head-load worker.
    • Sweeper/ Sanitation worker.
    • Home-based worker/ Artisan/ Tailor.
    • Transport worker/ Driver/ Conductor/ Helper to drivers and conductors/ Cart puller/ Rickshaw puller.
    • Shop worker/ Assistant/ Peon in small establishment/ Helper/Delivery assistant / Attendant/ Waiter.
    • Electrician/ Mechanic/ Repair worker.
    • Washer-man/ Chowkidar.

As per the SECC 2011, the following beneficiaries are automatically excluded:

• Households having motorized 2/3/4 wheeler/fishing boat.
• Households having mechanized 3/4-wheeler agricultural equipment.
• Households having Kisan Credit Card with credit limit above Rs. 50,000/.
• Household member is a government employee.
• Households with non - agricultural enterprises registered with government.
• Any member of household earning more than Rs. 10,000/ - per month.
• Households paying income tax.
• Households paying professional tax.
• House with three or more rooms with pucca walls and roof.
• Owns a refrigerator.
• Owns a landline phone.
• Owns more than 2.5 acres of irrigated land with 1 irrigation equipment.
• Owns 5 acres or more of irrigated land.
• Owning at least 7.5 acres of land or more with atleast one irrigation equipment.

Benefits of PM-JAY

Benefits

• AB-PMJAY provides a defined benefit cover of Rs. 5 lakh per family per year.

• To ensure that nobody is left out (especially women, children and elderly).
• There will be no cap on family size and age in the scheme.

Beneficiary Level

• More than 10.74 crore poor and vulnerable families (approximately 50 crore beneficiaries) covered across the country.
• All families listed in the SECC database as per defined criteria will be covered.

• Priority to girl child, women and senior citizens.
• Free treatment available at all public and empanelled private hospitals in times of need.
• Covers secondary and tertiary care hospitalization.
• 1,350 medical packages covering surgery, medical and day care treatments, cost of medicines and diagnostics.
• All pre-existing diseases covered.
• Hospitals cannot deny treatment.
• Hospitals will not be allowed to charge any additional money from beneficiaries for the treatment.
• Eligible beneficiaries can avail services across India.
• Can reach out for information, assistance, complaints and grievances to a 24X7 helpline number – 14555.

 Health System

• Help India to achieve Universal Health Coverage (UHC) and Sustainable Development Goals (SDG).
• Significantly reduce out of pocket expenditure for hospitalization.
• Strengthen public health care systems through infusion of insurance revenues.
• Enable creation of new health infrastructure in rural, remote and under-served areas.
• Increase health expenditure by Government as a percentage of GDP.
• Enhanced patient satisfaction.
• Improved health outcomes.
• Improvement in population-level productivity and efficiency.
• Improved quality of life.

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