Stories of health and hope

• The story of 18-year-old Raju (name changed) is emblematic of how the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) has transformed healthcare for millions of vulnerable families across India.
• Diagnosed with a life-threatening heart condition and burdened with medical debt, Raju’s family was on the verge of financial collapse. However, with timely intervention through PMJAY, Raju underwent a life-saving surgery, underscoring the scheme’s pivotal role in safeguarding both health and economic stability.
• This program, launched in 2018, is a cornerstone of India's commitment to Universal Health Coverage (UHC) and reflects the government's broader vision for ensuring equitable healthcare access for all.

The Scope and Impact of PMJAY:

• Over the past six years, PMJAY has facilitated around 7.8 crore hospital admissions, providing a safety net for millions of families who might otherwise be plunged into poverty due to healthcare expenses.
• The scheme offers free treatment up to Rs 5 lakh per family for secondary and tertiary care, which, though modest compared to private health insurance packages, is life-altering for the socio-economically disadvantaged.

Healthcare Coverage for Vulnerable Populations:

• PMJAY targets the bottom 40% of the population, ensuring that those most at risk of medical impoverishment have access to essential treatments. A recent study noted that the bottom 50% of India’s population has become significantly less vulnerable to medical cost shocks in the past decade, a trend closely linked to the success of PMJAY.

Inpatient and Outpatient Care: Bridging the Gap:

• While PMJAY focuses primarily on inpatient secondary and tertiary care, the Ayushman Arogya Mandirs (AAMs), earlier known as Health and Wellness Centres.
• Over 1.75 lakh AAMs provide free consultations, medicines, and diagnostics, reflecting a comprehensive approach to healthcare delivery in India.
• The convergence between PMJAY and primary healthcare services is crucial for the success of Universal Health Coverage (UHC), as it ensures continuity of care and addresses the full spectrum of health needs, from preventive to curative services.

Health Benefit Package and Pricing Revisions:

• PMJAY’s Health Benefit Package (HBP) has seen significant updates since its inception. The number of procedures covered has increased from 1,393 in 2018 to 1,949 by 2022, ensuring broader coverage and improved access to medical treatments.
• Moreover, states have been given flexibility to adjust HBP rates to local contexts, promoting more equitable and effective service delivery. This is critical in a country with vast disparities in healthcare infrastructure and access.

Technological Advancements and Seamless Delivery:

• A key feature of PMJAY is its technology-driven, paperless, and cashless nature, which minimizes the scope for corruption and ensures seamless service delivery.
• By eliminating the need for reimbursement or co-payment, the scheme provides direct and hassle-free healthcare access to beneficiaries.

Recent Expansions: Coverage for ASHA Workers and Senior Citizens:

• This year, the government extended PMJAY coverage to two critical groups:
• ASHA and Anganwadi workers: Recognizing the contribution of frontline workers, approximately 37 lakh families of these workers are now covered under the scheme.
• Senior citizens: In response to India's rising life expectancy, PMJAY’s coverage was extended to all citizens aged 70 and above, regardless of socio-economic status. This will benefit around 4.5 crore families and 6 crore senior citizens, many of whom face chronic illnesses and disabilities.
• This expansion is particularly significant given the Longitudinal Ageing Study of India (LASI) 2021, which revealed that 75% of the elderly suffer from one or more chronic diseases.

Public-Private Synergy: A National Healthcare Network:

• PMJAY has created a robust healthcare network with more than 29,000 empanelled hospitals, of which 13,000 are in the private sector. Over 57% of hospital admissions are in the private sector, indicating significant participation from private hospitals, especially in Tier-2 and Tier-3 cities.
• By creating a market for healthcare services in previously underserved areas, PMJAY has the potential to spur the growth of private hospitals in smaller towns, improving healthcare access for a larger portion of the population.

Empowering Public Healthcare Systems:

• In addition to strengthening private healthcare, PMJAY has also benefited public sector hospitals, which have used reimbursed funds to upgrade their facilities and infrastructure. This has led to an overall improvement in service delivery across many states, further contributing to India’s healthcare landscape.

Conclusion: PMJAY as a Pillar for a Viksit Bharat:

• As India progresses towards its goal of becoming a Viksit Bharat (Developed India), PMJAY stands out as a fundamental pillar in the nation's healthcare framework.
• By addressing healthcare costs for the most vulnerable, fostering public-private partnerships, and expanding coverage to key demographics, the scheme is not only improving health outcomes but also enhancing national productivity and prosperity. Health, after all, is the foundation upon which the future of any nation is built.