AB-PMJAY: Accelerating the growth of health care

With PMJAY becoming the world’s largest successful health care scheme, many countries have learned from the model and adapted it (with suitable tweaks) for their demographics.

It was a hot day in May 2021, when 65-year-old Bhulao Devi collapsed in her home in Bihar’s Arrah district. Her neighbours rushed her to a local hospital. After emergency treatment, the doctors asked her son, Dharmendra, to take her to Patna for further tests. She was diagnosed with a heart problem, and an urgent percutaneous transluminal coronary angioplasty was done.

AB-PMJAY aligns with the government’s idea of working together, instead of thinking in isolation. (HT Photo)

Fortunately, Devi was enrolled under the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY). “When the doctor says your mother has only a few hours to live, do you want to use this time to arrange for her treatment, or run around for money? If you are an AB-PMJAY beneficiary, you have nothing to worry about; if you are not, they will be the longest hours of your life,” says Dharmendra. Devi’s story is among millions of stories that manifest the Narendra Modi government’s resolve to leave no citizen behind while working to realise the Sabka Saath, Sabka Vikas, Sabka Vishwas vision.

The government has prioritised accelerating the transformation of health care and taken concrete steps towards the National Health Policy (NHP) 2017. NHP recommended several measures to achieve Universal Health Coverage: Improved access and affordability of quality secondary and tertiary care services through public hospitals and strategic purchasing of services from private care providers. NHP also suggested a reduction in out-of-pocket health care expenditure and the proportion of households experiencing catastrophic health expenditures. Since its launch on September 23, 2018, approximately 35 million treatments (worth more than ₹40,000 crore) have been provided and more than 18 million eligible individuals have been provided Ayushman cards. The milestones in 3.5 years, even as the health care infrastructure grappled with the pandemic, are a testament to the prime minister’s vision and the government’s efforts.

All this would not have been possible without pursuing a multipronged approach that addressed accessibility, affordability, and quality of care. Out of more than 24,000 hospitals empanelled under the scheme, nearly 10,000 are from the private sector, giving the beneficiary multiple avenues to seek treatment. At the same time, the scheme provided public hospitals with an opportunity to monetise health care services offered free of cost and, thereby, utilise the amount earned to undertake infrastructure- and manpower-related improvements.

The scheme also ensures gender parity for women, who account for approximately 50% of Ayushman cardholders and 47% of authorised hospital admissions, as per the National Health Authority (NHA). This has been possible as there is no restriction on the size of the family covered under PMJAY. The portability feature of the scheme also allows a beneficiary to avail of treatment anywhere in the country. More than 425,000 portability treatments have been authorised so far.

One of the most significant achievements of the scheme is the development and deployment of an award-winning IT platform, which is now active across 26 states and Union Territories. This has paved the way for NHA and state health agencies to leverage granular insights from the scheme to help in evidence-based policymaking and course-correction. NHA has also instituted robust anti-fraud protocols and established a national anti-fraud unit to proactively address frauds and beneficiary grievances.

Over the years, several steps have been taken to ensure ease, convenience, and choice to citizens in delivering health care. To ensure that beneficiaries do not have to go anywhere to get the Ayushman card, a door-to-door card generation drive under the Aapke Dwar Ayushman is being implemented. Eligible beneficiaries can now create their Ayushman cards through an open platform developed by NHA.

In addition, the government is strengthening the delivery of health care under AB-PMJAY. As part of a continuous process, NHA recently released the Health Benefits Package (HBP) 2022. Under HBP 2022, 365 new procedures were added, taking the count of total procedures to 1,949. Several high-end new procedures have also been added to provide the benefit of the latest medical treatments to beneficiaries. HBP 2022 has also introduced differential pricing to address regional variations in the cost of health care.

Under the Modi government, India has witnessed several revolutionary initiatives. AB-PMJAY aligns with the government’s idea of working together, instead of thinking in isolation. With PMJAY becoming the world’s largest successful health care scheme, many countries have learned from the model and adapted it (with suitable tweaks) for their demographics.

VK Paul is member (Health), NITI Aayog

The views expressed are personal