PM-JAY: Transforming Healthcare and Strengthening Financial Security

Why in the News ?

A recent study highlights the significant impact of Pradhan Mantri Jan Arogya Yojana (PM-JAY) on healthcare access and financial stability in India. It has reduced loan delinquency rates, out-of-pocket expenses, and improved health outcomes for beneficiaries.

PM-JAY: Transforming Healthcare and Strengthening Financial Security

Impact on Healthcare and Financial Security:

  • Comprehensive Health Coverage: Pradhan Mantri Jan Arogya Yojana (PM-JAY), India’s largest government-funded health insurance scheme, provides ₹5 lakh annual coverage per family for 500 million economically vulnerable beneficiaries.
  • Financial Resilience: A 35% reduction in loan delinquency rates among beneficiaries and a 9% decrease in out-of-pocket expenditure (OOPE) were observed, easing financial stress and preventing debt cycles.
  • Improved Access and Outcomes: Over 9 million hospital admissions worth ₹1.16 trillion were authorized, and health insurance coverage increased by 152% in PM-JAY districts.

Economic and Social Benefits

  • Enhanced Economic Stability: PM-JAY decreased health-related borrowing by 4.2% and improved loan repayment capacity, reducing dependence on informal credit.
  • Behavioral Changes: Beneficiaries are no longer delaying necessary treatments due to financial constraints. Improved healthcare access has led to better health-seeking behavior and economic productivity.
  • Strengthened Healthcare Infrastructure: Private-sector participation increased, particularly in tier-2 and tier-3 cities, enhancing healthcare delivery.

Global Model for Healthcare Reform

  • Inspiration for Developing Nations: Recognized by the World Health Organization and World Bank, PM-JAY is a blueprint for universal health coverage in developing countries.
  • Leveraging Technology and Partnerships: PM-JAY integrates public-private partnerships, digital platforms, and robust fraud detection mechanisms for efficient service delivery.
  • Way Forward: Increasing awareness, targeted outreach, and data analytics can enhance utilization and impact. The scheme’s success offers insights for health sector reforms

About Pradhan Mantri Jan Arogya Yojana (PM-JAY):

●      Introduction:

○       Launched on 23rd September 2018 in Ranchi, Jharkhand by Prime Minister Narendra Modi.

○       Part of Ayushman Bharat program, providing health cover of ₹5 lakhs per family per year for secondary and tertiary care hospitalization.

●      Key Features:

○       World’s largest government-funded health insurance scheme covering over 12 crore families (approx. 55 crore beneficiaries).

○       Cashless and paperless treatment at public and private empanelled hospitals nationwide.

○       Covers 1,929 medical procedures including pre and post-hospitalization expenses.

○       No restrictions on family size, age, or gender.

○       Benefits are portable across India.

●      Benefits:

○       Reduces catastrophic health expenditure and financial burden on poor families.

○       Ensures universal health coverage and promotes preventive healthcare.