Decoding Ayushman Bharat: A Beacon of Health & Hope

  Sansad TV   Mar 7, 2025  Add to Reading List

Expansion of PM-JAY Scheme for Senior Citizens

The Union Cabinet has recently expanded the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (PM-JAY) to include all senior citizens aged 70 years and above, which will directly benefit over 6 crore elderly individuals across India. This extension ensures that senior citizens receive free hospitalization, with the added provision of the Ayushman Vaya Vandana Card for easy identification and access to services.

Key Features of PM-JAY for Senior Citizens

  • Eligibility Criteria:
    • Age: Available to all individuals aged 70 or older, irrespective of their income or economic status.
    • Aadhaar Verification: Mandatory e-KYC through Aadhaar for enrollment.
  • Benefits:
    • Free Health Coverage: Senior citizens are entitled to hospital treatment worth up to Rs 5 lakh per family each year, beyond the existing Rs 5 lakh coverage under the PM-JAY scheme.
    • No Income Requirement: The benefit is available to senior citizens regardless of their financial situation.
    • Immediate Activation: Coverage begins immediately after enrollment, with no waiting periods.
    • Dual Coverage: Senior citizens can access PM-JAY benefits alongside private health insurance.
    • Choice for Retirees: Government retirees need to choose between PM-JAY and their existing health schemes (such as CGHS), as dual benefits are not allowed.

Understanding PM-JAY (Pradhan Mantri Jan Arogya Yojana)

Launched in 2018, Ayushman Bharat is India's flagship initiative aiming for Universal Health Coverage (UHC), focusing on providing financial protection for healthcare, especially for vulnerable groups.

  • Components:
    • Health and Wellness Centres (HWCs): These centers provide comprehensive healthcare services, ranging from preventive to curative care, with a focus on bringing healthcare closer to communities.
    • Pradhan Mantri Jan Arogya Yojana (PM-JAY): Offers up to Rs 5 lakh per family annually for secondary and tertiary hospitalization. The scheme targets the poorest 40% of the population, covering around 12 crore vulnerable families. It allows access to healthcare in over 29,000 empanelled hospitals across the country.

Benefits of PM-JAY for Families and Individuals

  • Financial Protection: PM-JAY has supported nearly 7.8 crore beneficiaries, shielding them from catastrophic medical expenses. The Rs 5 lakh coverage helps families avoid financial strain due to hospitalization costs.
  • Improved Access: Over 29,000 hospitals (including 13,000 private ones) are part of the scheme, providing extensive coverage across remote areas, with 57% of hospital admissions happening in private hospitals.
  • Empowering Women: 49% of Ayushman Bharat cards have been issued to women, ensuring equal access to health services.
  • Broadening Healthcare Coverage: The Health Benefit Package (HBP) has expanded from 1,393 to 1,949 procedures, making it more inclusive of various medical conditions.

PM Ayushman Bharat Health Infrastructure Mission (PM-ABHIM)

PM-ABHIM, previously known as PMASBY, was introduced with a Rs 64,180 crore budget to enhance healthcare infrastructure across primary, secondary, and tertiary levels. The scheme focuses on strengthening the country’s health systems, with an emphasis on pandemic preparedness, disease surveillance, and research on infectious diseases.

Challenges Facing PM-JAY

  • Fraudulent Claims: Issues like fraudulent beneficiary registrations and irregularities in treatment claims have been reported. The Comptroller and Auditor General (CAG) highlighted anomalies, such as patients receiving treatment posthumously and duplicate registrations linked to a single mobile number.
  • Infrastructure Gaps: Many public hospitals, especially in rural areas, lack essential infrastructure, trained personnel, and medical equipment, limiting the quality of services.
  • State Disparities: States like West Bengal, Odisha, and Delhi have opted out of PM-JAY, leading to unequal benefits across the country.
  • Indirect Costs: While PM-JAY covers hospitalization costs, it does not account for indirect costs like transportation, loss of income, and post-hospitalization expenses, which still leave beneficiaries vulnerable.
  • Weak Primary Healthcare: While the scheme focuses on secondary and tertiary care, primary healthcare facilities like Health and Wellness Centres (HWCs) are still underfunded and need more resources.
  • Limited Awareness: Lack of awareness and administrative barriers often prevent eligible individuals, especially in remote areas, from benefiting from the scheme.

The Way Forward for PM-JAY

  • Improving IT and Fraud Prevention: The introduction of better data validation tools and fraud detection systems will help identify anomalies, such as duplicate records and fraudulent claims. A dedicated fraud detection unit within the National Health Authority (NHA) could oversee and address irregularities.
  • Strengthening Healthcare Infrastructure: Investment in rural healthcare infrastructure, including upgrading facilities and recruiting trained medical professionals, is essential to ensure high-quality care for all beneficiaries.
  • Addressing Regional Gaps: Efforts should be made to bring non-participating states into the fold, offering incentives and flexibility to integrate their local health programs with PM-JAY.
  • Covering Indirect Costs: To ensure holistic financial protection, the scheme could be expanded to cover indirect costs like travel, lost wages, and post-hospitalization care. Micro-insurance schemes could help alleviate these expenses for the poorest families.
  • Enhancing Primary Healthcare: Strengthening Health and Wellness Centres (HWCs) with better infrastructure, medicine supplies, and a focus on preventive healthcare can improve overall health outcomes.
  • Expanding Outreach and Awareness: Governments need to conduct widespread awareness campaigns, particularly in rural and underserved areas, to ensure that all eligible individuals are informed about PM-JAY and can easily access its benefits.
  • Better Monitoring and Auditing: Strengthening monitoring mechanisms, including regular audits and real-time surveillance of empanelled hospitals, will help prevent fraud and ensure compliance with scheme guidelines.

Through these reforms, PM-JAY can become even more efficient and inclusive, ensuring that the elderly, marginalized groups, and the underserved have access to affordable and quality healthcare.