The Indian government introduced the Ayushman Bharat program as a cornerstone initiative in alignment with the National Health Policy 2017. It aims to realize the vision of Universal Health Coverage (UHC), reflecting the commitment to the Sustainable Development Goals (SDGs) and the principle of ensuring inclusivity by “leaving no one behind.”
Ayushman Bharat represents a shift from fragmented healthcare delivery to a more inclusive and tailored approach. This initiative seeks to revolutionize the healthcare system by implementing innovative strategies that address the entire spectrum of healthcare needs, from preventive measures to ambulatory care, across primary, secondary, and tertiary levels. Embracing a holistic continuum of care, Ayushman Bharat comprises two interconnected components aimed at ensuring comprehensive healthcare coverage.
- Health and Wellness Centres (HWCs)
- Pradhan Mantri Jan Arogya Yojana (PM-JAY)
1. Health and Wellness Centers (HWCs)
In February 2018, the Indian Government launched a plan to create 150,000 Health and Wellness Centers (HWCs) by upgrading existing Sub Centers and Primary Health Centers. These centers aim to provide Comprehensive Primary Health Care (CPHC) directly to communities, covering maternal and child health services and addressing non-communicable diseases. They offer free essential drugs and diagnostic services, aiming to make healthcare more accessible and fair. By focusing on health promotion and prevention, these centers help people and communities adopt healthier habits, reducing the risk of chronic diseases and improving overall well-being.
2. Pradhan Mantri Jan Arogya Yojana (PM-JAY)
Prime Minister Narendra Modi inaugurated the Pradhan Mantri Jan Arogya Yojana (PM-JAY), a vital aspect of Ayushman Bharat, on September 23, 2018, in Ranchi, Jharkhand. It stands as the world’s largest health assurance scheme, aiming to extend a health coverage of Rs. 5 lakhs annually per family for secondary and tertiary care hospitalization. This initiative targets over 12 crores impoverished and vulnerable families, encompassing approximately 55 crore beneficiaries, constituting the bottom 40% of India’s population.
We identify eligible households based on deprivation and occupational parameters outlined in the Socio-Economic Caste Census 2011 (SECC 2011) for rural and urban areas, respectively. Initially known as the National Health Protection Scheme (NHPS), PM-JAY absorbed the pre-existing Rashtriya Swasthya Bima Yojana (RSBY), initiated in 2008. Consequently, PM-JAY’s coverage extends to families previously enrolled in RSBY but not included in the SECC 2011 dataset. The Government fully funds this scheme, with the Central and State Governments sharing implementation costs.
Key Features of PM-JAY
- PM-JAY is the world’s largest health insurance/assurance scheme fully financed by the government.
- It offers a cover of Rs. 5 lakhs per family per year for secondary and tertiary care hospitalization across public and private empanelled hospitals in India.
- Over 12 crore poor and vulnerable entitled families (approximately 55 crore beneficiaries) are eligible for these benefits.
- There is no restriction on family size, age, or gender.
- PM-JAY provides cashless access to health care services for beneficiaries at the point of service, namely the hospital.
- It envisions to help mitigate catastrophic expenditure on medical treatment that pushes nearly 6 crore Indians into poverty each year.
- It covers up to 3 days of pre-hospitalization and 15 days post-hospitalization expenses such as diagnostics and medicines.
- All pre-existing conditions are covered from day one.
- Benefits of the scheme are portable across the country, allowing beneficiaries to visit any empanelled public or private hospital in India for cashless treatment.
- Services include approximately 1,929 procedures covering all costs related to treatment, including but not limited to drugs, supplies, diagnostic services, physician’s fees, room charges, surgeon charges, OT, and ICU charges.
- Public hospitals are reimbursed for healthcare services at par with private hospitals.
Benefit Cover Under PM-JAY
Government-funded health insurance in India used to have limited coverage, usually ranging from INR30,000 to INR3,00,000 per family annually, creating a fragmented system. But with the Pradhan Mantri Jan Arogya Yojana (PM-JAY), things have changed for the better. Now, eligible families can get cashless coverage of up to INR5,00,000 per year for specified secondary and tertiary care conditions. This covers all expenses related to treatment outlined in the scheme.
- Medical examination, treatment and consultation
- Medicine and medical consumables
- Non-intensive and intensive care services
- Diagnostic and laboratory investigations
- Medical implantation services (where necessary)
- Accommodation benefits
- Food services
- Complications arising during treatment
- Post-hospitalization follow-up care up to 15 days