Introduction about Ayushman Bharat Yojana (AB-PMJAY)
But then, a revolution happened in September 23, 2018. Prime Minister Narendra Modi Launched the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana. This scheme has turned out to be a game changer in India’s Medical & Health Infrastructure.
There are many more reasons by which this scheme can be considered a revolution in India which have benefitted the Low-income earners, roughly the bottom 50% of the country's population. This is why it’s become mandatory for us to get all the information and Updates about Ayushman Bharat Yojana (AB-PMJAY). And this is why, In this blog, we have added all the information about Ayushman Bharat Yojana (AB-PMJAY). This blog is also going to help you in UPSC Prelims Ayushman Bharat Yojana (AB-PMJAY).
So, let’s start-
What we’ll learn today?
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What is Ayushman Bharat Yojana (AB-PMJAY)? – Ayushman Bharat Mission |
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Quick Facts about Ayushman Bharat Yojana (AB-PMJAY)
We have added a few and most important Quick Facts about this Scheme below:
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Fact |
Information |
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Full Name of scheme |
Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (PM-JAY) |
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Scheme Abbreviations |
PM-JAY, Ayushman Bharat PM-JAY |
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Launch Date |
September 23, 2018 |
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Launched by |
Prime Minister Narendra Modi |
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Objective |
To provide health coverage to economically vulnerable families |
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Coverage Amount |
Up to 5 lakh rupees per family per year |
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Beneficiary Selection |
Based on Socio-Economic Caste Census (SECC) data |
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Target Beneficiaries |
Low-income earners, roughly the bottom 50% of the country's population |
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Program Coverage |
Primary care services through family doctors; free secondary and tertiary healthcare for specialist treatment and hospitalization |
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Hospitalization Coverage |
Secondary and tertiary healthcare services |
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Payment Method |
Cashless treatment at empaneled hospitals |
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Family Size |
No cap on the number of family members covered |
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Pre-existing Conditions |
Covered from day one of enrollment |
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Empaneled Hospitals |
Wide network of public and private hospitals |
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Maternity Care |
Special packages for pregnant women and neonates |
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Scale |
World's largest government-sponsored healthcare program, serving approximately 500 million people |
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Type of Project |
Health insurance |
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Administrative Body |
National Health Authority |
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Country |
India |
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Prime Minister(s) |
Narendra Modi |
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Ministry |
Ministry of Health and Family Welfare |
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Launched |
September 23, 2018; 5 years ago |
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Budget |
₹8,088 crore (US$1.0 billion) for 2021–22 [1] |
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Status |
Active |
What is Ayushman Bharat Yojana (AB-PMJAY)? – Ayushman Bharat Mission
The essence of Ayushman Bharat lies in its transition from a fragmented, sectoral approach to healthcare delivery towards a comprehensive, need-based system. This scheme seeks to revolutionize the entire healthcare ecosystem, encompassing prevention, promotion, and ambulatory care, spanning across primary, secondary, and tertiary levels. This visionary initiative comprises two integral components:
1. Health and Wellness Centres (HWCs)
2. Pradhan Mantri Jan Arogya Yojana (PM-JAY):
Health and Wellness Centres (HWCs): Announced in February 2018, this component involves the transformation of existing Sub Centres and Primary Health Centres into 1,50,000 Health and Wellness Centres (HWCs). These centers serve as the cornerstone of Comprehensive Primary Health Care (CPHC), bringing healthcare closer to people's homes.
They offer a wide range of services, from maternal and child health to managing non-communicable diseases, including the provision of essential drugs and diagnostics. Emphasizing health promotion and prevention, these centers empower individuals and communities to adopt healthier lifestyles.
With its extensive reach, comprehensive benefits, and a commitment to reducing the financial burden of medical expenses, Ayushman Bharat is a transformative force in India's healthcare landscape, striving to make quality healthcare accessible to all.
Overview of Pradhan Mantri jan Arogya Yojana
PM-JAY builds on socio-economic criteria, particularly the Socio-Economic Caste Census 2011 (SECC 2011), to identify eligible households. Formerly known as the National Health Protection Scheme (NHPS) and incorporating the Rashtriya Swasthya Bima Yojana (RSBY) from 2008, this fully government-funded program ensures cashless access to healthcare services at empaneled hospitals nationwide.
It addresses catastrophic medical expenses, covering pre- and post-hospitalization costs, including diagnostics and medicines, with no family size, age, or gender restrictions. Moreover, it covers pre-existing conditions from day one and is portable across India.
Background of Ayushman Bharat Yojana
Key statistics reveal that over 20% of India's population still lives below the INR 150 per day poverty line, and a demographic shift is underway, with more than 34% of the population projected to fall in the 15-35 age group by 2021. This demographic potential is threatened by India's unique "triple burden of disease," comprising communicable diseases, non-communicable diseases (NCDs), and injuries, which places an escalating demand on healthcare services.
Despite this growing healthcare need, India's supply side faces challenges. A significant portion of healthcare services is provided by the private sector, with small and unregulated facilities predominating. Public sector hospitals, on the other hand, are overwhelmed, underfunded, and often hindered by a shortage of resources and healthcare workers.
The persistent underfunding of India's public healthcare system, with government expenditure stagnating at 1.2% of GDP, has led to high out-of-pocket expenses, pushing millions into poverty each year.
Objectives of Ayushman Bharat Yojana
1. To provide financial protection against catastrophic health expenses.
2. To ensure access to quality healthcare services for eligible families.
3. To cover all family members without restrictions on age, gender, or family size.
4. To manage and treat pre-existing medical conditions.
5. To make healthcare benefits portable across India.
6. To reduce the incidence of medical-related poverty.
7. To promote a balanced healthcare ecosystem with public and private sector participation.
8. To expand access to a wide range of medical procedures and treatments.
9. To improve healthcare infrastructure and service quality.
10. To encourage timely medical interventions and hospitalization.
11. To prevent medical debt and financial distress for eligible beneficiaries.
12. To mitigate the burden of non-communicable diseases and injuries.
13. To ensure equitable healthcare access for economically disadvantaged families.
14. To strengthen the healthcare system by reducing fragmentation.
15. To foster public-private partnerships for comprehensive healthcare delivery.
Eligibility for PM-JAY Scheme - PMJAY Qualification
PMJAY Rural Eligibility Criteria
1. Scheduled Caste and Scheduled Tribe Households: Families belonging to scheduled caste and scheduled tribe households are eligible for PMJAY health cover.
2. Beggars and Alms Recipients: Individuals and families who survive on begging or alms are eligible beneficiaries.
3. Families with No Adults Aged 16-59: Families that do not have any individuals aged between 16 and 59 years can avail of PMJAY benefits.
4. Physically Challenged Member: Families with at least one physically challenged member and no able-bodied adult member are eligible.
5. Landless Households: Families that earn their livelihood by working as casual manual laborers and do not own land are eligible for the scheme.
6. Primitive Tribal Communities: Members of primitive tribal communities can benefit from PMJAY.
7. Legally Released Bonded Laborers: Families that were previously bonded laborers but have been legally released are eligible.
8. One-Room Makeshift Houses: Families living in one-room makeshift houses with no proper walls or roofs can avail of PMJAY health cover.
9. Manual Scavenger Families: Families engaged in manual scavenging are eligible beneficiaries.
PMJAY Urban Eligibility Criteria
1. Occupational Category: Urban workers' families in specific occupational categories listed in the Socio-Economic Caste Census 2011 are eligible for PMJAY.
2. Rashtriya Swasthya Bima Yojana (RSBY): Any family enrolled under the Rashtriya Swasthya Bima Yojana will also benefit from PMJAY.
3. Occupational Categories: Eligible urban beneficiaries include individuals working in various occupations such as washermen, watchmen, rag pickers, mechanics, electricians, repair workers, domestic help, sanitation workers, gardeners, sweepers, home-based artisans, handicraft workers, tailors, cobblers, hawkers, plumbers, masons, construction workers, porters, welders, painters, security guards, transport workers, assistants, peons, delivery boys, shopkeepers, and waiters.
Exclusion Under PMJAY Scheme
1. Ownership of a two, three, or four-wheeler or a motorized fishing boat.
2. Ownership of mechanized farming equipment.
3. Possession of kisan cards with a credit limit exceeding Rs. 50,000.
4. Employment by the government.
5. Employment in government-managed non-agricultural enterprises.
6. Monthly income exceeding Rs. 10,000.
7. Ownership of refrigerators and landlines.
8. Ownership of decent, solidly built houses.
9. Possession of 5 acres or more of agricultural land.
Benefits of PMJAY Scheme
1. Enhanced Coverage
While previous schemes provided limited annual coverage ranging from INR 30,000 to INR 3,00,000 per family, PM-JAY extends cashless cover of up to INR 5,00,000 per eligible family annually.
2. Comprehensive Coverage
This scheme also includes diagnostic and laboratory investigations, medical implantation services as required, accommodation benefits, food services, and even complications arising during treatment.
3. Flexible Family Usage
4. Inclusive Coverage
5. Immediate Coverage
6. Reduction in Out-of-Pocket Expenses
7. Catering to Diverse Medical Needs
8. Learnings-Based Design
The removal of caps and immediate coverage for pre-existing diseases are among the improvements based on past learnings.
9. Comprehensive Health Assurance
Packages and Rates related to PM-JAY
This is achieved through a meticulous system of Packages and Rates, which serves as the backbone of the program, ensuring transparency, affordability, and comprehensive coverage in healthcare delivery.
Packages and Rates under PM-JAY
1. Package Structure: The cornerstone of PM-JAY's financial model lies in the concept of packages, which define the scope and cost of healthcare services. These packages encompass all aspects of treatment, including pre and post-hospitalization expenses, providing a holistic approach to healthcare coverage.
- Surgical Packages: Surgical packages are bundled care plans, where a single comprehensive payment is made to the empanelled healthcare provider (EHCP). This payment covers various components like registration charges, bed charges, surgeons' fees, and the cost of surgical appliances.
- Medical Packages: Medical packages are based on a per-day rate, contingent on the patient's admission unit, whether it's the general ward, High Dependency Unit (HDU), or Intensive Care Unit (ICU). These packages also include additional charges depending on the specific admission unit.
- Day-Care Packages: Similar to surgical packages, day-care packages follow the bundled payment structure, ensuring that a wide range of treatments are covered efficiently.
2. Comprehensive Coverage: The treatment packages under PM-JAY are remarkably comprehensive, encompassing nearly 24 specialities, including super-specialty care such as oncology, neurosurgery, and cardio-thoracic and cardiovascular surgery.
3. Components Included in Package Rates: The package rates within PM-JAY encompass an extensive list of components to ensure that patients receive comprehensive care without any hidden costs. These components include registration and bed charges, nursing and boarding fees, fees of healthcare practitioners, the cost of surgical appliances and prosthetic devices, medications, pathology and radiology tests, and even the patient's food expenses.
4. Pre and Post-Hospitalization Expenses: PM-JAY's package rates extend beyond hospitalization. They cover expenses incurred for consultations, diagnostic tests, and medicines before admission, as well as up to 15 days post-discharge for the same ailment or surgery.
5. Flexibility and Approval Process: Hospitals have the flexibility to request higher rates for surgical conditions not listed in the package, but approval must be obtained from the insurer or State Health Agency (SHA) before providing treatment, up to a maximum limit of INR 1,00,000.
Evolution to HBP 2.0
1. Concerns Addressed
2. Specialist Committees and Data Analysis
3. Governing Board Approval
4. Flexibility to States
Advantages of HBP 2.0
1. Enhanced Coverage
2. Reduced Burden on Patients
3. Continuity of Care
4. Fraud Prevention
5. Improved IT Customization
Futures of PMJAY Scheme
1. Government Financing: PM-JAY is the world's largest government-funded health insurance/assurance scheme, providing financial coverage for healthcare expenses.
2. Generous Coverage: Beneficiaries are entitled to coverage of up to Rs. 5 lakhs per family per year, extending to secondary and tertiary care hospitalization.
3. Extensive Eligibility: Over 12 crore economically disadvantaged families, comprising approximately 55 crore individuals, are eligible for the scheme's benefits.
4. Cashless Access: PM-JAY ensures cashless access to healthcare services at the point of service, primarily within public and private empanelled hospitals across India.
5. Poverty Alleviation: The scheme aims to mitigate the financial burden of medical treatment, which often leads to nearly 6 crore Indians falling into poverty each year.
6. Comprehensive Coverage: PM-JAY covers expenses for up to 3 days of pre-hospitalization and 15 days of post-hospitalization, including diagnostics and medicine costs.
7. Inclusive: There are no restrictions on family size, age, or gender, making it accessible to all eligible individuals.
8. Pre-Existing Conditions: PM-JAY covers all pre-existing medical conditions from day one of enrollment, ensuring comprehensive healthcare.
9. Portability: The scheme allows beneficiaries to seek cashless treatment at any empanelled public or private hospital across the country.
10. Wide Service Range: PM-JAY encompasses approximately 1,929 procedures, covering all expenses related to treatment, including drugs, supplies, diagnostic services, physician's fees, room charges, surgeon charges, OT and ICU charges, and more.
11. Equal Reimbursement: Public hospitals are reimbursed for healthcare services at the same rates as private hospitals, ensuring equitable access to quality care.
Application Process of PMJAY – Ayushman Bharat Yojana
The registration process for Ayushman Bharat Yojana, specifically the Pradhan Mantri Jan Arogya Yojana (PMJAY), is as follows:
1. Visit the PMJAY Portal: Go to the official PMJAY website.
2. Check Eligibility: Click on the "Am I Eligible" section on the website.
3. Enter Details: Provide your mobile number and the CAPTCHA code, then click on "Generate OTP" (One-Time Password).
4. Select Your State: Choose your respective state from the options provided.
5. Search for Eligibility: You can search for eligibility using various criteria such as your name, HHD (Household ID) number, ration card number, or mobile number.
6. Verify Coverage: Based on the search results, you can verify if your family is covered under PMJAY.
Alternatively, you can determine your eligibility by approaching any Empanelled Health Care Provider (EHCP) or by calling the Ayushman Bharat Yojana call centre at either 14555 or 1800-111-565.
Challenges of Ayushman Bharat – Pradhan Mantri jan Arogya Yojana
Ayushman Bharat – Pradhan Mantri jan Arogya Yojana has faced many challenges till now, and there are many more challenges has to come in this journey. We have listed some of key challenges below:
1. Reconciliation with existing health development recommendations.
2. Infrastructure development to modernize the national health system.
3. Shortage of healthcare professionals, particularly doctors.
4. High prevalence of infectious diseases.
5. Comparatively low central government investment in healthcare.
6. Healthcare challenges beyond the Health Ministry's purview, such as urban development and transportation.
7. Limited participation of private corporate hospitals.
8. Resistance of private hospitals to provide specialized services at government-specified rates.
9. Misuse of the Ayushman Bharat scheme by private hospitals through fake medical billing.
10. False claims for surgeries and dialysis.
11. Instances of fraudulent cases leading to significant fines.
12. Concentration of high-value claims in specific districts and hospitals.
13. Indications of an anti-women bias in healthcare coverage.
14. Risks of unscrupulous private entities profiteering from the system.
15. Ongoing efforts to curb fraudulent activities within AB-PMJAY.
Ayushman Bharat Health Card - ABHC
This card empowers economically weaker and impoverished families by providing them access to free medical treatment in hospitals, with coverage of up to Rs 5 lakh per person. To obtain an Ayushman Bharat Card in 2023, interested individuals should follow these steps:
1. Check Eligibility: Applicants must determine their eligibility by visiting the official website and using the "Am I Eligible" option. Eligibility criteria include belonging to the Economically Weaker Sections (EWS), Lower Income Group (LIG), or SC/ST category.
2. Aadhar Card Verification: To confirm eligibility, applicants are required to provide their Aadhar Card Number, which will be used to assess their qualification for the scheme.
3. Application Submission: Once eligibility is confirmed, applicants should fill out the Ayushman Bharat Form for 2023 and complete the registration process.
4. Application Verification: After submitting the application, authorities will review and verify the information provided.
5. Inclusion in Ayushman Bharat List: Upon successful verification, eligible individuals will have their names included in the Ayushman Bharat list for 2023.
Ayushman Bharat Digital Mission - ABDM
It aims to establish a robust digital health infrastructure and standardized identification systems to bridge gaps among healthcare stakeholders. The ABDM envisions a connected healthcare ecosystem that enhances accessibility, efficiency, and patient control over health information.
Components of Ayushman Bharat Digital Mission:-
1. ABHA Number: A standardized identification system for individuals to ensure accurate medical record creation and access with informed patient consent.
2. Healthcare Professionals Registry (HPR): A repository of healthcare professionals from modern and traditional medicine systems, connecting them to India's digital health ecosystem.
3. ABHA Mobile App (PHR): An electronic health record managed, shared, and controlled by individuals, conforming to national interoperability standards.
4. Health Facility Registry (HFR): A comprehensive database of health facilities, both public and private, including hospitals, clinics, laboratories, and pharmacies.
5. Unified Health Interface (UHI): An open protocol facilitating digital health services like appointment booking, teleconsultation, and service discovery between patients and healthcare providers.
Ayushman Bharat Health Account – ABHA
Benefits of ABHA
1. Unique & Trustable Identity: ABHA establishes a distinct identity across various healthcare providers, ensuring seamless recognition within the healthcare ecosystem.
2. Unified Benefits: It links all healthcare benefits, ranging from public health programs to insurance schemes, to an individual's unique ABHA number, streamlining access to these services.
3. Hassle-free Access: ABHA eliminates the need for lengthy registration processes at healthcare facilities across the country, making access to healthcare services more convenient.
4. Easy PHR Sign Up: It enables straightforward sign-up for Personal Health Records (PHR) applications like ABDM ABHA for health data sharing.
Quick Facts About ABHA
We have mentioned some of Quick facts about ABHA Below:
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Facts |
Description |
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ABHA Number |
46,07,44,941 |
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ABHA Linked Health Record |
31,02,42,026 |
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Health Facilities Registered |
2,19,863 |
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Healthcare Professionals Registered |
2,29,888 |
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Health Records App Downloads |
32,79,747 |
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Active Integrators |
1,093 |
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Successful Integrators |
130 |
ABHA Number
ABHA Address
FAQ’s Related to Ayushman Bharat Yojana - ABPMJAY UPSC – PM JAY UPSC
Question-1:
What is Ayushman Bharat Yojana (ABY)?
Question-2:
How do I register for Ayushman Bharat Yojana (PMJAY)?
Question-3:
What is the Ayushman Card Registration process?
Question-4:
What are the benefits of Ayushman Bharat Health Card?
Question-5:
Is Ayushman Bharat Scheme the same as PM Ayushman Bharat Scheme?
Question-6:
Under which ministry does PMJAY fall?
Question-7:
Who is eligible for PMJAY?
Question-8:
What are the components of Ayushman Bharat Digital Mission?
Question-9:
What is ABHA Number and how is it used?
Question-10:
How do I download the ABHA Mobile App?
Question-11:
What is the aim of Ayushman Bharat Yojana UPSC?
Question-12:
What are PMJAY Guidelines?
Question-13:
What is the contact number for PMJAY inquiries?
Question-14:
What is the qualification for PMJAY eligibility?
Question-15:
What is Ayushman Bharat Health Account (ABHA)?
Question-16:
What is Ayushman Bharat Scheme UPSC all about?
Question-17:
What is the PMJAY scheme under Ayushman Bharat?
Question-18:
How can I verify my eligibility for Ayushman Bharat?
Question-19:
What is the significance of PMJAY UPSC 2022 for UPSC aspirants?
Question-20:
What are the main objectives of Ayushman Bharat Mission UPSC?
Question-21:
What is the Ayushman Bharat PMJAY UPSC initiative's impact?
Question-22:
What role do Active Integrators play in ABHA?
Question-23:
How does ABHA Address help in health data exchange?
Question-24:
What is the Unified Health Interface (UHI) in ABDM?
Question-25:
What is the coverage limit under PMJAY for eligible families?
Question-26:
What are the key statistics related to ABHA?
Question-27:
What is the primary goal of Ayushman Bharat Yojana?
Question-28:
What is the purpose of the Ayushman Bharat Health Card?
Question-29:
How does the Ayushman Bharat Yojana address the healthcare challenges in India?
Question-30:
What steps can UPSC aspirants take to understand Ayushman Bharat for their
exams?
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