Ayushman Bharat – Pradhan Mantri Jan Aarogya Yojana (AB-PMJAY) is a landmark initiative launched by Prime Minister Narendra Modi on 23rd September 2018 in Ranchi, Jharkhand. It’s primary aim is to provide accessible, affordable, and equitable healthcare to all citizens, particularly focusing on the vulnerable sections of society. As the world’s largest government-funded healthcare program, AB-PMJAY aspires to cover over 50 crore beneficiaries, making quality healthcare a reality for millions of Indian families.
- Ministry
- Ministry of Health and Family Welfare
Benefits of the Scheme
- Coverage
- The scheme provides health coverage of up to ₹5 lakhs per family per year for secondary and tertiary care hospitalization.
- Targets
- It targets over 10.74 crore vulnerable families (around 50 crore beneficiaries) identified through the Socio-Economic Caste Census (SECC).
- Cashless and Paperless access
- Ensures cashless and paperless access to healthcare services at empaneled and listed hospitals.
- Reduces catastrophic healthcare expenditures that push families into debt.
- Facilitates quality health services without financial hardships, advancing the vision of Universal Health Coverage (UHC).
Key Features of AB-PMJAY
- Comprehensive Healthcare Approach:
- Focuses on promotive, preventive, curative, palliative, and rehabilitative aspects.
- Health and Wellness Centers (HWCs):
- The plan is to establish 1,50,000 HWCs providing Comprehensive Primary Health Care (CPHC).
- It covers maternal, child health services, and non-communicable diseases with free drugs and diagnostics.
- First HWC inaugurated in Jangla, Chhattisgarh, on 14th April 2018.
- Hospitalization Coverage:
- Offers a wide range coverage for secondary and tertiary care without restrictions on family size, age, or pre-existing conditions.
- It also includes 1350 medical procedures covering pre and post-hospitalization, diagnostics, and medications.
- Beneficiaries can effortlessly enjoy services across the country at empaneled healthcare providers.
State Collaboration and Federal Process
- Flexibility
- States have flexibility in designing and implementing the scheme based on local needs while following the national guidelines.
- Implementation
- Implementation options include working through insurance companies, trusts/societies, or mixed models.
Progress and Implementation
- State MOUs:
- Agreements signed with 30 states/UTs, with states like Maharashtra and Tamil Nadu joining in 2018.
- Pilot Launch:
- Conducted across 22 states/UTs in over 1280 hospitals to test IT systems like the Beneficiary Identification System (BIS) and Transaction Management System (TMS).
- Training Programs:
- Creation of a trained cadre of Pradhan Mantri Aarogya Mitras (PMAMs) to assist beneficiaries.
- Training programs held across 27 states, training 3936 personnel, including 3519 Aarogya Mitras.
IT and Fraud Prevention Measures
- IT Systems:
- Developed robust systems for beneficiary identification and tackling hospital transaction management.
- Focused on data privacy and security with policies adhering to national and international standards like ISO 27001 and GDPR.
- Anti-Fraud Mechanisms:
- Establishment of anti-fraud cells at national and state levels.
- Use of advanced IT tools to detect and prevent fraudulent activities.
Empanelment and Beneficiary Outreach
- Hospital Network:
- Over 15,686 applications received for empanelment to ensure widespread access.
- Beneficiary Identification:
- Collaboration with Common Service Centres (CSCs) for beneficiary identification.
- Personalized letters with unique family codes sent to identified families to simplify the enrollment process.
