New Delhi: Ayushman Bharat- Pradhan Mantri Jan Arogya Yojana (PM-JAY) completed one year of operation today. Prime Minister Shri Narendra Modi had launched PM-JAY on September 23, 2018 from Ranchi, Jharkhand. In this short period of 12 months, 46.4 lakh hospital treatments, worth Rs 7,500 crores have been carried out, and 60% of the amount spent is on tertiary care.

PM-JAY is the flagship scheme of the Government of India, with an aim to bring quality healthcare to around 50 crore poor and vulnerable Indians across India. The scheme gives annual healthcare benefits of up to Rs 5 lakh for every entitled family. PM-JAY is the world’s largest fully Government funded health insurance

As on date, the scheme has been implemented in 32 States and Union Territories. In the true spirit of cooperative federalism, NHA and States have worked with a strong partnership approach. Various States are using different models for implementing their own health insurance/assurance schemes. Considering the fact that States are at different levels of preparedness and have varying capacity to manage such schemes, PM-JAY provides the States with the flexibility to choose their implementation model.  17 States/UT are implementing PM-JAY via the Trust Mode, 9 States/UTs via Insurance Mode and 6 States/UTs are using the Mixed Mode (Mixed mode is a combination of Trust mode and Insurance mode).

In order to enable PM-JAY swiftly and effortlessly, IT provides a robust backbone to the scheme’s implementation throughout the county. Focused efforts are being made to ensure that the poor and vulnerable are made aware of their entitlements, and e-cards are issued to these beneficiaries. In one year, 10.3 crore e-cards have been issued to entitled beneficiaries under PM-JAY. This is more than the total combined population of France and Canada. The distribution of e-cards is continuing to take place at a very fast pace. 3 e-cards are being distributed every second across the length and breadth of India, and 91% e-cards linked with Aadhar, which aids verification of the entitled beneficiaries.

Dr. Indu Bhushan, CEO, NHA said “Our focus is to ensure that more and more vulnerable Indians are being made aware of their entitlements, so that they can avail of the hospitalization benefits during their illness. PM-JAY, aims to ensure improved healthcare delivery, through a combination of government hospitals and strategic purchasing of services from private hospitals, in health care deficit areas”.

In order to cater to the demands under PM-JAY, and also to ensure quality care to the beneficiaries, 51 hospitals are being empanelled every day, which is helping to build a network of hospitals that conform to quality standards. More than 18,236 hospitals have been empanelled across India to ensure optimal accessibility to the eligible families. Out of the total hospitals empanelled, 53% are private, especially multi-specialty.  There are 9 hospital admissions every minute across the hospitals in India. PM-JAY provides cashless and paperless access to services for the beneficiary at the point of service. Under PM-JAY, for the hospitals, vast majority (85%) of the claims have been paid within time.

Highlighting the participation by private sector, Dr. Indu Bhushan said, “The uptake of PM-JAY by private sector providers has been very encouraging. We have many private hospitals empanelled under PM-JAY. We are working on getting the top corporate hospitals on board, so that beneficiaries have maximum choices”.

Many Indians migrate and travel, mainly due to work. A unique feature of PM-JAY is its portability, which has helped the eligible poor and migrant workers to seek treatment outside their states. So far, there have been 42,631 portability cases.

At PM-JAY, a holistic beneficiary empowerment system is implemented via call centre, auto SMS, PM-JAY website, self-help portal, Central Grievance Redressal System, Prime Minister’s letter, PM-JAY mobile app. The website and call centre with toll-free helpline no. 14555 have significantly helped in guiding patients to seek healthcare as well as to send their feedback and grievances for timely redressal. The multi-lingual call centre providing round the clock support, answering 45 lakh calls. In today’s digital India, more than 1.5 crore people have used the mere.pmjay.gov.in website, to check their eligibility.

It has been a momentous start for PM-JAY, and there is a long journey ahead, that will build on the successes. The scheme will continue to focus on reducing catastrophic out-of-pocket health expenditure, improving access to quality health care and meeting the unmet need of the population for hospitalization care.