AB-PMJAY led to huge out-of-pocket expenditure savings, says Govt

A total of 3.14 crore beneficiaries were benefited during the last two years under the Centre's ambitious health insurance scheme, MoS Health said

The Ayushman Bharat - Pradhan Mantri Jan Arogya Yojana has resulted in huge out-of-pocket expenditure savings related to hospitalisations for the targeted beneficiaries, Minister of State for Health S P Singh Baghel told the Rajya Sabha on Tuesday.

A total of 3.14 crore beneficiaries were benefited during the last two years under the Centre's ambitious health insurance scheme, he said.

The states/UTs having maximum and minimum number of beneficiary families supported by the Centre and state are Uttar Pradesh and Lakshadweep, respectively, Baghel said in a written reply.

Responding to a question, he said in Gujarat, Ayushman Bharat - Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) is implemented in convergence with the state scheme Mukhyamantri Amrutum.

As of July 19, 2023, a total of 41.34 lakh hospital admissions worth Rs 8,564 crore have been authorised under the scheme in Gujarat, Baghel stated.

For the financial year 2022-23, central share of funds of Rs 6,048 crore were released during the last two years to states and Union territories implementing the scheme.

Responding to a separate question, the minister said AB-PMJAY is the largest publicly funded health assurance scheme in the world which aims to provide health cover of Rs 5 lakh per family per year for secondary and tertiary care hospitalisation to 12 crore families.

Further, many states and UTs implementing AB PM-JAY have expanded the beneficiary base under the scheme to approximately 15.5 crore families at their own cost.

"As of July 19, 2023, 5.39 crore hospital admissions worth Rs 66,236 crore have been authorised which is a direct out-of-pocket expenditure saving," Baghel said in his written reply.

Further, if these services would have been availed from the market, the cost would have been at least 1.5-2 times higher as the package rates under PM-JAY benefit from the economy of the scale, he said.

Therefore, Ayushman Bharat PM-JAY has resulted in huge out-of-pocket expenditure saving related to hospitalisations for the targeted beneficiaries.

At the time of launching of the AB PM-JAY, it was decided to cover a total of 10.74 crore families eligible as per six deprivation and 11 occupational criteria across rural and urban areas, respectively.

Further, left over Rashtriya Swasthya Bima Yojana (RSBY) families were also included, he explained.

Together, they constituted the bottom 40 per cent of India's population as per the 2011 census.

However, considering the decadal population growth of India, the Cabinet has approved the expansion of the beneficiary base from existing 10.74 crore to 12 crore beneficiary families in 2022, Baghel stated.

Further, many states/UTs implementing AB PM-JAY have expanded the beneficiary base under the scheme to approximately 15.5 crore families, at their own cost.

Further, in order to ensure that eligible beneficiaries get covered under the scheme, the National Health Authority (NHA) has provided flexibility to states/UTs to use non-SECC beneficiary family database with similar socio-economic profiles for tagging against the leftover (unauthenticated) SECC families.

Accordingly, many states have shared database of poor and vulnerable families against unidentified SECC (Socio Economic and Caste Census) families and the expanded beneficiary base. These databases have been integrated with NHA's IT system for card creation, Baghel added.