Stories of Health and Hope: How Ayushman Bharat Is Saving Lives

Why in News?

• The Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) represents a crucial chapter in India’s journey toward Universal Health Coverage (UHC).
• Introduced with the vision of PM Modi, this scheme has become a lifeline for millions of families by providing accessible, affordable, and quality healthcare.
• The program’s design, implementation, and continued expansion underscore India's commitment to improving health outcomes and reducing the economic burden of medical expenses on vulnerable populations.

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

• AB-PMJAY is a flagship health insurance scheme launched by the Government of India on September 23, 2018, to provide financial protection against high medical costs for economically vulnerable families.
• Targeting around 10.74 crore vulnerable families (approximately 500 million individuals), the scheme offers a health cover of up to ₹5 lakh per family per year for secondary and tertiary care hospitalisation.
• It covers about 1,350 medical packages, including surgeries, treatments, medicines, and diagnostics, and ensures cashless and paperless treatment across public and empanelled private hospitals.
• Implemented by the National Health Authority (NHA) in collaboration with state health agencies, AB-PMJAY operates through two main components: PMJAY, which focuses on providing health insurance, and Health and Wellness Centres (HWCs), which deliver primary healthcare services.

An Assessment of the Impact of AB-PMJAY on Healthcare Access

• Reducing Financial Barriers and Ensuring Access to Care
  • Prior to the implementation of PMJAY, many low-income families faced a significant risk of slipping into poverty due to high out-of-pocket expenses on healthcare.
  • Even relatively minor medical procedures could push a family into financial ruin.
  • By covering hospitalisation costs, PMJAY has provided a financial cushion that allows families to seek treatment without worrying about immediate expenses.
  • This has particularly benefited those with chronic conditions or sudden illnesses that require repeated or extensive hospital stays.
  • For many, this scheme has meant the difference between foregoing treatment due to cost and receiving life-saving care without the burden of debt.
• Improving Health Equity and Reaching Underserved Populations
  • One of the significant achievements of PMJAY has been its role in improving health equity across India.
  • The scheme specifically targets economically weaker sections of society, thereby ensuring that those most in need of financial protection can access essential healthcare services.
  • This is particularly important in rural areas, where access to quality healthcare has traditionally been limited.
  • Before the scheme’s introduction, residents of these areas often faced the dual challenge of inadequate medical facilities nearby and the inability to afford treatment even if they travelled to larger cities.
• Expanding the Range of Treatments Available
  • The impact of PMJAY extends beyond just financial support; it has also expanded the types of medical treatments available to beneficiaries.
  • Since the scheme’s launch, the Health Benefit Package (HBP) has been revised and expanded, increasing the number of procedures covered from 1,393 in 2018 to 1,949 by 2022.
  • This expansion includes a wide range of treatments and procedures for serious conditions, such as cardiac surgeries, cancer therapies, and orthopaedic interventions, which are typically unaffordable for those without insurance.
  • This means that PMJAY beneficiaries can now access more advanced and life-saving treatments without the worry of prohibitive costs.
• Empowering Families Through Cashless Treatment
  • One of the unique features of PMJAY is its focus on cashless treatment, which is a critical factor in improving healthcare access.
  • Many people from low-income backgrounds avoid seeking medical help due to the requirement of upfront payments.
  • The cashless nature of PMJAY means that patients do not need to pay anything out of pocket at the time of admission or treatment.
  • This is particularly beneficial in emergencies, where delays in treatment due to lack of immediate funds could be life-threatening.
  • With PMJAY, families can focus on the well-being of their loved ones without the added stress of arranging finances at short notice.

Some Other Notable Aspects of PMJAY

• Integration with Primary Healthcare Services
  • PMJAY focuses on inpatient secondary and tertiary care, while outpatient services fall under a parallel initiative; the comprehensive primary healthcare mission.
  • This program has established over 1,75,000 Ayushman Arogya Mandirs (AAMs), formerly known as HWCs, which offer free consultations, essential medicines, and diagnostic services.
  • This dual approach aims to provide continuity of care, linking primary health services with more advanced medical care under PMJAY.
  • The model emphasises the need to view healthcare policy holistically, ensuring that citizens have access to a complete spectrum of services from primary consultations to complex hospital treatments.
• Enhancing Healthcare Delivery through Technological Innovation
  • A key feature of PMJAY is its technology-driven, paperless, and cashless operation, which helps streamline the delivery of services and reduce opportunities for abuse within the system.
  • The scheme’s no-reimbursement and no co-payment policy ensures that beneficiaries can access healthcare without upfront payments, making the process more user-friendly.
  • While most claim settlements occur without delay, ongoing efforts aim to enhance efficiency in collaboration with state governments.
  • This streamlined approach has contributed to the scheme's broad reach and effectiveness.
• Recent Expansions and Inclusivity
  • Reflecting the government’s commitment to public welfare, PMJAY has expanded to include new beneficiary groups.
  • In the interim budget, the scheme was extended to around 37 lakh families of ASHA and Anganwadi workers.
  • Additionally, recognising the challenges faced by India’s growing elderly population, the government has extended PMJAY to all citizens aged 70 and above, irrespective of their socioeconomic status.
  • This expansion will benefit approximately 4.5 crore families, providing critical support to senior citizens who face higher hospitalisation rates and often struggle with multiple chronic conditions.
  • Unlike many private insurance plans that exclude pre-existing conditions or impose waiting periods, PMJAY offers immediate coverage, enabling the elderly to access necessary care without delay.
• Strengthening Public Hospitals and Reducing Economic Vulnerability
  • PMJAY has also improved public sector hospitals, allowing them to reinvest funds received from the scheme into enhancing their infrastructure and services.
  • This has led to improved service delivery in several states and has elevated the quality of care available in government facilities.
  • Furthermore, a recent study based on data from the Household Consumption Expenditure Survey 2022-23 indicates that the bottom 50% of India’s population is now less vulnerable to health-related financial shocks than a decade ago.
  • This reduction in economic vulnerability is closely linked to the financial protection offered by PMJAY, highlighting its role in alleviating the burden of medical expenses on low-income families.

Conclusion

• AB-PMJAY is more than a healthcare scheme; it is a cornerstone of India’s vision for a healthier and more prosperous nation.
• Health is a fundamental pillar of societal well-being, productivity, and national progress, and through PMJAY, India has taken a significant step toward ensuring that its citizens receive the care they need to live healthy, dignified lives.

As India moves toward the goal of building a Viksit Bharat (Developed India), PMJAY will continue to play a pivotal role. 

Q) What is the primary objective of the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY)?

The primary objective of AB-PMJAY is to provide financial protection against high medical costs for approximately 10.74 crore economically vulnerable families in India, covering up to ₹5 lakh per family per year for secondary and tertiary hospital care.

Q) How has AB-PMJAY improved healthcare access for underserved populations?

AB-PMJAY has improved healthcare access by specifically targeting economically weaker sections, ensuring that vulnerable families can access essential services without the burden of high out-of-pocket expenses. The scheme has also expanded the range of covered treatments, offering cashless services that eliminate the need for upfront payments. 

Source:The Indian Express