Three years since the Ayushman Bharat-Pradhan Mantri Jan Arogya Yojana began, it is yet to meet one of its main objectives
Three years after the Ayushman Bharat-Pradhan Mantri Jan Arogya Yojana (AB-PMJAY or PM-JAY) was launched in September 2018, the scheme has been unable to meet one of its most important objectives--of providing 'cashless and paperless access to healthcare for patients at the point of care.
The "world's largest government-funded healthcare program" was a step towards Universal Health Coverage (UHC), the government said and would provide quality health services to eligible patients and protect them from financial hardship.
However, as a study from Chhattisgarh has found, PM-JAY has failed to plug the shortcomings of previous publicly funded health insurance (PFHI) schemes--it has not decreased families' out-of-pocket expenditure on health or increased use of hospital care substantially. In addition, it does not offer outpatient consultation, and the program is underfunded to support its beneficiaries, we found from studies and speaking to experts.
An explainer of what's wrong, and how it can be fixed.
What is PM-JAY?
Ayushman Bharat aims to provide 110 million "poor, deprived rural families" and specific occupational categories of urban workers' families, such as those of beggars, rag pickers, domestic workers, and street vendors, with an annual family health insurance cover of up to Rs 5 lakh for the treatment of diseases that cannot be cured at a primary healthcare center. The beneficiaries were selected based on the 2011 Socio-Economic and Caste Census.
PM-JAY subsumed two other centrally sponsored schemes--the Rashtriya Swasthya Bima Yojana (RSBY), which was launched in 2008 and insured families of informal sector workers below the poverty line (BPL) for up to Rs 30,000 per family, and the Senior Citizen Health Insurance Scheme (SCHIS), which was launched in 2006, and provides an additional Rs 30,000 for every senior citizen in families eligible for RSBY.
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