Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY)

What’s in today’s article?

• Why in news?
• What is Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY)?
• What is the Eligibility criteria of AB-PMJAY?
• What are the Benefits AB-PMJAY?
• What is the Role of National Health Authority (NHA)?
• What are the achievements of AB-PMJAY?
• News Summary: PMJAY registration- CAG reports 7.5 lakh recipients linked to single number
• Key highlights of the report

Why in news?

• The Comptroller and Auditor General of India (CAG) has highlighted irregularities in the registration and validation of beneficiaries under the Ayushman Bharat- Prime Minister Pradhan Mantri Jan Aarogya Yojana (PMJAY).
• In its audit report on Performance Audit of AB-PMJAY, tabled in Lok Sabha, the CAG said that overall, 7,49,820 beneficiaries were linked with a single mobile number in the Beneficiary Identification System (BIS) of the scheme.

What is Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY)?

About

• Launched in September 2018, the scheme aimed to offer secondary and tertiary care services to the vulnerable population in the society.
  • It was launched as a second component of the ‘Ayushman Bharat’ scheme.
• This scheme aimed to offer medical coverage of Rs. 5 lakh per family per year for secondary and tertiary care hospitalisation to poor and vulnerable families.
• The scheme covers over nearly 40% of the population targeted towards poorest and the vulnerable.

What is the Eligibility criteria of AB-PMJAY?

• The scheme is targeted to cover 10.74 crore poor, deprived rural families and identified occupational category of urban worker’s families.
• The beneficiaries as identified by latest Socio-Economic Caste Census (SECC) data.

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What are the Benefits AB-PMJAY?

• It provides cashless access to health care services for the beneficiary at the point of service, i.e., the hospital.
• Under the scheme every eligible family will be given Rs 5 lakh Insurance coverage benefit per year.
• It offers Health Benefit Packages which covers surgery, medical and day care treatments, cost of medicines and diagnostics.

What is the Role of National Health Authority (NHA)?

• NHA is the apex body responsible for implementing India’s flagship public health insurance/assurance scheme – Ayushman Bharat Pradhan Mantri Jan Arogya Yojana.
• It has been entrusted with the role of:
  • designing strategy, building technological infrastructure and
  • implementation of National Digital Health Mission to create a National Digital Health Eco-system.
• To implement the scheme at the State level, State Health Agencies (SHAs) in the form of a society/trust have been set up by respective States.

What are the achievements of AB-PMJAY?

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Image Caption: Achievements of AB-PMJAY

News Summary: PMJAY registration- CAG reports 7.5 lakh recipients linked to single number

• In its audit report on Performance Audit of AB-PMJAY, the CAG has revealed that nearly 7.5 lakh beneficiaries were linked with a single cell phone number — 9999999999.
• The report stated that 7.87 crore beneficiary households were registered, constituting 73% of the targeted households of 10.74 crore (November 2022).
  • Later, the government increased the target to 12 crore.

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Image caption: Registration of Beneficiaries against same or invalid mobile numbers

Key highlights of the report

• Significance of mobile number
  • Mobile numbers are significant for searching records related to any beneficiary in the database, who may approach the registration desk without the ID.
  • In case of loss of e-card, identification of the beneficiary may also become difficult.
  • This may result in denial of scheme benefits to eligible beneficiaries as well as denial of pre- and post-admission communication causing inconvenience to them.
• Pointed out unrealistic household size for registered beneficiaries under PMJAY
  • Data analysis revealed that in 43,197 households, the size of the family was unrealistic, ranging from 11 to 201 members.
  • Presence of such unrealistic members in a household in the BIS database indicates:
    • lack of essential validation controls in the beneficiary registration process, and
    • the possibility that beneficiaries are taking advantage of the lack of a clear definition of family in the guidelines.
  • The National Anti-Fraud Unit has sent periodic reminders to the States/UTs highlighting discrepancies in verified data.
  • However, ‘Public Health’ being a State subject, the final decision in this regard vests with the State Governments
• Many pensioners found possessing PMJAY cards
  • Many pensioners in Chandigarh, Haryana, Himachal Pradesh, Karnataka, Maharashtra and Tamil Nadu were found possessing PMJAY cards and availing treatment under the scheme.
• Delayed action in weeding out the ineligible beneficiaries
  • Audit observed that delayed action in weeding out the ineligible beneficiaries resulted in ineligible persons availing benefits of the Scheme and excess payment of premium to the insurance companies.

Q1) What is Socio-Economic Caste Census (SECC)?

The Socio-Economic Caste Census (SECC) is a large-scale socioeconomic survey conducted in India to gather information about the economic and social status of households and individuals. It aims to provide a comprehensive and detailed database for the effective targeting of various government welfare schemes and programs. The SECC gathers data on a wide range of parameters, including income, education, employment, housing conditions, and social caste categories.

Q2) What is Comptroller and Auditor General of India (CAG)?

The Comptroller and Auditor General of India (CAG) is an independent constitutional authority responsible for auditing and overseeing the financial accounts and transactions of the Government of India and the state governments. The CAG plays a crucial role in ensuring transparency, accountability, and proper management of public funds and resources.

Source: PMJAY registration: CAG reports 7.5 lakh recipients linked to single number | National Health Authority | PMJAY | Mygov.in