Transforming Healthcare: Six Years of Ayushman Bharat PM-JAY

As a key component of the Ayushman Bharat initiative, which emerged from the National Health Policy 2017, PM-JAY has transformed the healthcare landscape by providing health coverage to the country’s most vulnerable.

With an ambitious goal of covering over 12 crore families, or nearly 55 crore individuals, PM-JAY has become the largest health assurance scheme in the world, offering comprehensive secondary and tertiary care hospitalisation benefits of up to Rs.5 lakh per family annually.

Over the past six years, PM-JAY has sought to address the deep-rooted health inequities in India, prioritising the poorest 40 per cent of the population based on the Socio-Economic Caste Census 2011. This initiative marked a paradigm shift from segmented healthcare services to an integrated, need-based approach, aligning with the nation’s commitment to the Sustainable Development Goals (SDGs) and ensuring that “no one is left behind.”

In a landmark decision, the Union Cabinet approved an expansion of the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB PM-JAY) on September 11, 2024, offering comprehensive health insurance to senior citizens aged 70 and above. This move will provide free health coverage of up to Rs.5 lakh per family, regardless of income, benefiting around 6 crore senior citizens across 4.5 crore families.

Under this expansion, all senior citizens in this age group will receive a new distinct card under AB PM-JAY to access the scheme’s benefits. For senior citizens aged 70 and above who already belong to families covered by AB PM-JAY, an additional top-up cover of Rs.5 lakh per year will be provided exclusively for their use, separate from the rest of the family. Those who are not part of the existing scheme will receive Rs.5 lakh of annual coverage on a family basis.

Moreover, senior citizens already covered under public health insurance schemes like the Central Government Health Scheme (CGHS), Ex-Servicemen Contributory Health Scheme (ECHS), or Ayushman CAPF will have the option to either continue with their existing scheme or opt for AB PM-JAY.

Additionally, those under private health insurance policies or the Employees’ State Insurance scheme will also be eligible to avail of the benefits of AB PM-JAY. As of September 9, 2024, the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB PM-JAY) has significantly improved healthcare accessibility across India. Over 35.4 crore Ayushman cards have been issued, empowering millions of families with health coverage. The scheme is operational in 33 States and Union Territories, except NCT Delhi, West Bengal, and Odisha.

A key accomplishment is the authorisation of 7.79 crore hospital admissions, providing Rs.1,07,125 crore in financial coverage. Gender-wise utilisation shows that 49 per cent of the Ayushman cards have been issued to women, and 3.61 crore hospital admissions have been utilised by women, reflecting the scheme’s role in supporting gender equity in healthcare.

The scheme's portability feature allows beneficiaries to avail treatment at any empanelled hospital across India, regardless of their home state. Notably, 11.9 lakh hospitalizations worth Rs.3,100 crores have been authorized under this portability feature, enhancing accessibility for beneficiaries nationwide.

Furthermore, AB PM-JAY has successfully empanelled 30,529 hospitals across the country, with 17,063 public and 13,466 private hospitals, ensuring beneficiaries have a wide network of healthcare facilities to choose from.

As of September 1, 2024, the Ayushman Bharat PM-JAY has facilitated a diverse array of medical procedures, with significant hospital admissions authorized across various specialties. Celebrating six years of the Pradhan Mantri Jan Arogya Yojana (PM-JAY) highlights the countless lives touched and the communities empowered by this transformative initiative. The strides made toward a more inclusive healthcare system are evident in the positive changes experienced across the nation.

The Ayushman Bharat program has led to a remarkable 21 per cent reduction in out-of-pocket healthcare expenditures and an 8 per cent decrease in the incidence of emergency loans taken for health-related expenses. This relief allows families to focus on their well-being without the burden of financial stress.

Under PM-JAY, access to high-frequency, low-cost, life-saving procedures, such as dialysis, which typically costs Rs.10,000-15,000 per session, has become significantly more affordable for low-income families. This initiative has alleviated financial burdens, ensuring that essential treatments are within reach.

Without AB PM-JAY, the total cost of treatment would have been 1.5 to 2 times higher, leading to savings of over Rs.1.25 lakh crore in out-of-pocket expenses and facilitating 7.37 crore free hospital admissions. This impact underscores the scheme's role in transforming healthcare access and affordability.

The legacy of PM-JAY is also reflected in the significant increase in eye care procedures, enhancing vision for countless individuals and reaffirming the commitment to comprehensive health coverage for all. The transformative impact of PM-JAY continues to pave the way for a healthier, more equitable society.