Day 27 – Q 2.What is your assessment of the Pradhan Mantri jan Arogya Yojana? Has it been able to bring in positive transposition in people’s lives? Comment.

2. What is your assessment of the Pradhan Mantri jan Arogya Yojana? Has it been able to bring in positive transposition in people’s lives? Comment. 

प्रधानमंत्री जन आरोग्य योजना का आपका क्या आकलन है? क्या यह लोगों के जीवन में सकारात्मक बदलाव लाने में सक्षम है? टिप्पणी करें।

Introduction:

Launched in 2018, Pradhan Mantri Jan Arogya Yojana (PMJAY), under Ayushman Bharat umbrella is world largest healthcare program. The scheme extends access to hospital care for 10.74 Crore beneficiary families and about 50 crore Indian citizens. It is a Centrally Sponsored Scheme under the Ministry of Health and Family Welfare (MoHFW).

Body: 

Highlights of the Scheme

• The scheme guarantees eligible families are covered for inpatient expenses of up to Rs 5 lakh per year in any government or empanelled private hospitals all over India.
• It addresses concerns of expenditure by vulnerable families for secondary and tertiary care. The extension of comprehensive primary health care is given under Health and wellness centres.
• An autonomous and empowered National Health Agency (NHA) has been established with corresponding state-level health agencies (SHAs).
• The benefit cover under it also includes pre and post-hospitalization expenses.
• Unlike private insurance schemes, PMJAY does not exclude a person on account of pre-existing illnesses.
• One unique feature of the PMJAY is its national portability once fully operational.

 Assessment of the Scheme:

• PM-JAY has dramatically changed the picture of the health sector and directly benefit poor people.

• Increased benefit cover to nearly 40% of the population, especially the poorest & the vulnerable.

• The poor and vulnerable can now avail benefits in both public and empanelled private facilities. It ensures all people can access quality health services when and where they need them, without suffering financial hardship.

• It provides cashless and paperless access to services for the beneficiary at the point of service.

• It guarantees quality, affordability and accountability in the health system.
• It has rationalized the cost of care in the private sector.

But still there exist some Concerns and Challenges with PMJAY:

• PM-JAY focuses on secondary and tertiary care, taking away the attention from primary care and public health-related investments.
• Massive shortages in the supply of services (human resources, hospitals and diagnostic centres in the private/public sector). So PMJAY will raise the demand without raising supply.
• The current package prices are too low to encourage private-sector hospitals to fully participate in the scheme.
• Unfair practices by doctors and officials at every level.

• Hospital insurance addresses only a small amount of out-of-pocket expenditures
• Still, millions of people across India are pushed into poverty because of out-of-pocket spending on health care.
• PMJAY excludes the 500 million people or so of the middle-class segment. 

 Way Forward:

• Raise the percentage of GDP allocated to health from 1.2% today to 2.5% by 2022.
• Government hospitals need infrastructure and machinery up-gradation, which can be done by the earnings of public hospitals under PMJAY.
• Ensuring adaptive price setting, third-party monitoring, strict regulation, and quality improvements in public sector hospitals.
• PMJAY will need a gamut of skilled manpower as facilitators and administrative staffs at various levels.
• Universal health coverage (UHC) will require an insurance program for the middle class also.
• Need to strengthen the country’s primary care services.
• A larger share of India’s public health expenditure to be allocated to preventive care.