A Success Story: Ayushman Bharat- PMJAY now to cover excluded people

The focus this year will be on expanding the reach of the Ayushman Bharat- Pradhan Mantri Jan Aarogya Yojana (AB-PMJAY) network and services to other left-out population groups such as manual scavengers, road traffic victims, truck drivers, among others through convergence with other central health schemes, Union Health & Family Welfare Minister Dr Harsh Vardhan said while celebrating the 2nd Anniversary of AB-PMJAY. 

“Along with the recently launched National Digital Health Mission, which will build the necessary digital health ecosystem to enable enhanced access to safe, timely, quality and affordable healthcare for 1.3 billion Indians, Ayushman Bharat will become a pillar of  the country’s healthcare system,” he added. 

Lauding AB-PMJAY as a ‘historic step’, Dr. Harsh Vardhan noted, “As the world’s largest public-supported health assurance scheme, it provides financial risk protection to over 53 crore Indians from economically and socially disadvantaged backgrounds by assuring them with a health cover of Rs. 5 lakh per eligible family per year to avail cashless inpatient secondary and tertiary healthcare. It has provided treatments worth more than Rs. 15,500 crore. It has saved crores of lives and households from getting wiped out due to catastrophic expenditure on health that pushed an estimated 6 crore families below poverty line each year.” 

The Scheme was implemented in September 2018. In the last two years  the scheme has provided free treatment to more than 1.26 crore beneficiaries. Over 23,000 hospitals have been empanelled so far and more than 12.5 crore e-cards have been issued. 57% of the total amount utilised under PMJAY has been for tertiary procedures related to treatment of major illnesses like cancer, cardiac ailments, orthopaedic problems, and neo-natal.

Dr. Harsh Vardhan pointed out that 45% of the empanelled hospitals are private facilities providing 52% of the overall treatments and raising 61% of the hospital admissions claims amount. He also outlined the scheme’s portability as one of its outstanding feature. 

“An eligible patient from any state implementing PMJAY can avail of cashless treatment anywhere in India, in any empanelled hospital. Portability has been built into the design of the scheme and enabled 1.3 lakh citizens of the migrant population to avail of care at the nearest hospital.” 

The scheme has been implemented by 32 States and UT Governments. On the occasion, the Minister presented  awards to the winners of the Ayushman Bharat PMJAY Start-up Grand Challenge to support the implementation of PM-JAY along 7 implementation challenges such as beneficiary empowerment, increasing quality of care, minimizing fraud and abuse control, and hence, help transform healthcare delivery to the poorest citizens.

The Union Health Minister launched the AB PMJAY Joint Certification Programme. The promising programme will develop the skills and knowledge of relevant stakeholders in medical audit and health insurance for accurate and efficient processing of claims and prevention and detection of fraud and abuse.  On the occasion  “AB PMJAY Anti-Fraud Framework: Practitioners’ Guidebook” was also launched. This will serve as a useful tool for the States as it is a repository of the anti-fraud guidelines, techniques, advisories along with legal remedies/course of action presently available under applicable Indian laws. This Guidebook will serve as an excellent instrument for capacity building for the State Health Agencies to take effective measures for prevention, detection and deterrence of fraud under AB PMJAY.