Context: Since the inception of the Pradhan Mantri Jan Arogya Yojana (PMJAY), 34.27 crore cards have been issued, and 6.5 crore beneficiaries have received treatment across 30,000 empanelled hospitals. Despite its extensive reach, the program has encountered significant challenges, including substantial payment backlogs owed to hospitals by the government.
This financial strain has led some hospitals to either refuse or limit the number of PMJAY patients they accept, raising concerns about whether the scheme needs a design overhaul to address these challenges.
About Pradhan Mantri Jan Arogya Yojana (PMJAY):
Launched in: 2018
- Type of scheme: Centrally sponsored scheme
- Subsumed scheme: Rashtriya Swasthya Bima Yojana (RSBY) and the Senior Citizen Health Insurance Scheme (SCHIS).
- Key features: It is an entitlement-based scheme that targets the beneficiaries as identified by latest Socio-Economic Caste Census (SECC) data.
- It offers a sum insured of Rs.5 lakh per family for secondary care and tertiary care hospitalisation to the bottom 40 per cent of the population of India.
- It covers the cost of hospitalization, pre-hospitalization, medication, and post-hospitalization during the treatment of tertiary and secondary care procedures.
- The Ayushman Card is like a pre-paid card worth Rs 5 lakh, which can be used to avail free treatment at more than 27,000 empanelled hospitals.
- Every hospital must provide Pradhan Mantri Arogya Mitras (PMAMs) to assist beneficiaries.
- The National Health Authority (NHA) has been constituted as an autonomous entity under the Society Registration Act, 1860 for effective implementation of PM-JAY in alliance with state governments.
- The State Health Agency (SHA) is the apex body of the State Government responsible for the implementation of AB PM-JAY in the State.