Features of AB-PMJAY
A progression towards promotive, preventive, curative, palliative and rehabilitative aspects of Universal Healthcare through access of Health and Wellness Centres (HWCs) at the primary level and provision of financial protection for accessing curative care at the secondary and tertiary levels through engagement with both public and private sector.
Adopts a continuum of care approach, comprising of two inter-related components: Creation of 1, 50,000 Health and Wellness Centres, which will bring health care closer to the homes of the people.
HWCs will provide Comprehensive Primary Health Care (CPHC), covering both maternal and child health services and non-communicable diseases, including free essential drugs and diagnostic services.
The second component is the Pradhan Mantri Jan ArogyaYojana (PMJAY), which provides health protection cover to poor and vulnerable families for secondary and tertiary care.
HWCs will play a critical role in creating awareness about PMJAY, screening for non-communicable diseases, follow-up of hospitalization cases among others.
AB-PMJAY (Financial protection from catastrophic expenditure)
● 71st Round of National Sample Survey Organization (NSSO) has found 85.9 per cent of rural households and 82 per cent of urban households have no access to healthcare insurance/assurance. More than 17 per cent of Indian population spend at least 10 per cent of household budgets for health services. Catastrophic healthcare related expenditure pushes families into debt, with more than 24 per cent households in rural India and 18 per cent population in urban area have met their healthcare expenses through some sort of borrowings.
● PMJAY primarily targets the poor, deprived rural families and identified occupational category of urban workers’ families as per the latest Socio-Economic Caste Census (SECC) data for both rural and urban areas as well as the active families under the Rash triyaSw as thy a Bi ma Yoj ana( RS BY ). Approximately 10.74 crore identified families (approximately 50 crore beneficiaries) will be
entitled to get the benefits. There is no cap on family size and age as well as restriction on pre-existing conditions.
AB-PMJAY (Hospitalization cover from inpatient care to post hospitalisation care) ● Objectives are to reduce out of pocket hospitalisation expenses, fulfil unmet needs and improve access of identified families to quality inpatient care and day care surgeries. ● Provides a coverage up to Rs 5 lakh (about $7000) per family per year, for secondary and tertiary care hospitalization through a network of Empanelled Health Care Providers (EHCP).
● The EHCP network will provide cashless and paperless access to services for the beneficiaries at the both public and private hospitals.
● Includes 1350 procedures covering pre and post hospitalization, diagnostics, medicines etc.
Beneficiaries will be able to move across borders and access services across the country through the provider network seamlessly.
Progress of AB-PMJAY in States: 30 states and Union Territories have signed the MoU and have started working on implementation of the mission.
Pilot launch of PMJAY:
● The focus of the mission is to test and enhance the developed IT systems and streamline the state preparedness for a comprehensive launch ● Done in around 22 States / UTs
● Taking place in specific hospitals to test the Beneficiary Identification System (BIS) and Transaction Management System (TMS) systems.
● Involved over 1280 hospitals.
Hospital Empanelment: So far 15,686 applications for hospital empanelment have been received.
Fraud detection and Data privacy:
● Detailed guidelines have been prepared to address the issues around potential fraudulent activities that could be committed by any individual or organization.
● Anti-fraud cells will be established at the national and state level, and strong IT tools will be deployed to prevent and detect fraud.