Progressing Towards Universal Health Coverage

Key Highlights:

• Ayushman Bharat Pradhan Mantri-Jan Arogya Yojana (AB PM-JAY), India's flagship financial protection scheme, marks its 8th anniversary.
• The scheme provides annual cashless hospitalization coverage of up to Rs. 5 lakh per family to economically vulnerable citizens.
• It covers about 33% of India's population with Ayushman cards, having funded 13.25 crore admissions worth Rs. 2.03 lakh crore.
• AB PM-JAY has been expanded to include ASHAs, anganwadi workers, and senior citizens aged 70 years and above.
• It is complemented by Ayushman Arogya Mandirs (AAM), Ayushman Bharat Digital Mission (ABDM), and PM-Ayushman Bharat Health Infrastructure Mission (PM-ABHIM) to achieve universal health coverage.

Detailed Insights:

• AB PM-JAY offers cashless healthcare services for 1,961 procedures across 27 medical specialties, aiming to save families from catastrophic medical bills.
• Beneficiary identification is based on Socio-Economic Caste Census (SECC) 2011 deprivation criteria for rural areas and specific occupational categories for urban areas.
• Additional beneficiary categories include Building and Other Construction Workers, road accident victims under PM-RAHAT, transgender persons under SMILE, and Particularly Vulnerable Tribal Groups (PVTGs) under PM-JANMAN.
• The scheme is a centrally sponsored scheme, with a 60:40 Centre-State funding ratio, and 90:10 for North-Eastern States, Himachal Pradesh, Uttarakhand, and Jammu & Kashmir.
• Ayushman Arogya Mandirs (AAM) strengthen grassroots primary care by upgrading health centers, providing essential drugs/diagnostics, and facilitating e-Sanjeevani teleconsultations.
• Ayushman Bharat Digital Mission (ABDM) develops an integrated digital health ecosystem using Ayushman Bharat Health Account (ABHA) IDs, linking health records, and establishing registries for healthcare professionals and facilities.
• PM-Ayushman Bharat Health Infrastructure Mission (PM-ABHIM), with a budget of Rs. 64,180 crore (2021-2026), strengthens health infrastructure, disease surveillance, and research across urban and rural areas.

Key Concepts Involved:

• Universal Health Coverage (UHC): Ensuring all people have access to quality health services without financial hardship.
• Out-of-Pocket Expenditure (OOPE): Direct payments made by individuals to healthcare providers at the time of service use.
• Centrally Sponsored Scheme: Schemes funded by the Union Government but implemented by State Governments, with a defined sharing pattern.
• Cashless Hospitalisation: Medical treatment where the insurance company directly settles bills with the hospital, requiring no upfront payment from the patient.
• Socio-Economic Caste Census (SECC): A survey that collects data on socio-economic status of households in rural and urban areas.