Pradhan Mantri Jan Arogya Yojana (PM-JAY): Hits And Misses This Year

The Ayushman Bharat Yojana, also known as the Pradhan Mantri Jan Arogya Yojana (PM-JAY), has been in operation since 2018. However, on October 29, 2024, the government extended its coverage to include all senior citizens aged 70 and above, irrespective of their income level. With healthcare inflation hovering around 14 per cent, this expansion could bring significant relief to senior citizens, many of whom lack financial security in old age. For those without pensions or with limited savings, healthcare costs often become overwhelming.

Typically, healthcare needs arise the most in old age, and if one does not have enough health insurance at this point, the situation becomes difficult to handle. However, the PMJAY scheme’s expansion to include seniors of all economic backgrounds might be helpful for many who cannot afford health insurance or stop health insurance after retirement due to high premiums.

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How Pradhan Mantri Jan Arogya Yojana (PM-JAY) Supports People

The scheme provides cashless medical treatment at empanelled government and private hospitals. There are around 2000 medical procedures offered, however, state governments can further modify and expand packages, rates, and the list of hospitals under their jurisdiction.

As of December 12, 2024, there are 30,928 empanelled hospitals, including 17,102 public and 13,826 private facilities. Over 270 hospitals were added in November and so far in December alone. To date, the scheme has facilitated over 68.6 million (6.86 crore) admissions, with 1.87 million (18.7 lakh) in the last 30 days, according to the PM-JAY website.

According to the Ministry of Health and Family Welfare, notification at the beginning of this month, around 25 lakh Ayushman Vaya Vandana Cards have been issued since the scheme’s expansion, enabling senior citizens to access benefits worth Rs 40 crore.  As per the notification, Around 22,000 senior citizens have availed of treatments under the scheme, including procedures like hip replacements, cataract surgeries, gallbladder removal, stroke care, hemodialysis, coronary angioplasty, and more.

The most important benefit of the scheme is that all pre-existing diseases are covered from day one, with no waiting period. The beneficiaries are required to register for the facility and then they are issued an Ayushman card to access the services.

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Challenges And Concerns

As far as the scheme is concerned, it is useful to bring more people under the health coverage however, there is a need for more caution in empanelling hospitals under the scheme or it could be the source of income for hospitals while risking patients’ health.

In November, two patients reportedly died after undergoing unnecessary angioplasties at a PM-JAY empanelled private hospital in Ahmedabad, Gujarat. The hospital, which organised free check-up camps in villages, allegedly recommended angioplasty for patients who did not require the procedure, subsequently claiming payments from the government under the scheme. The hospital reportedly earned Rs 11 crore through PM-JAY claims last year, with 70 per cent of the amount linked to unnecessary treatments, reported PTI.

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While the scheme has expanded healthcare coverage to millions, challenges remain. The incident highlights the need for stricter monitoring and enforcement to ensure the scheme benefits its intended recipients and does not become a tool for unethical practices.

The PM-JAY scheme’s expansion to include senior citizens is a helpful move, offering much-needed financial and healthcare support. However, effective implementation, stringent oversight, and accountability are crucial to safeguard the program’s integrity and ensure it serves those in need.