Officially known as Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB PM-JAY), the scheme’s extension to cover septuagenarians and above was originally outlined in PM Modi’s election manifesto and subsequently announced by President Droupadi Murmu.
Now, the responsibility of officially launching and executing the scheme rests with the National Health Authority, a division under the Ministry of Health and Family Welfare.
PM-JAY, which is touted to be the world’s largest publicly funded health insurance scheme, covers around 55 crore beneficiaries from the bottom of the population — almost 40 per cent of India’s population. The scheme offers beneficiaries coverage of Rs 5 lakh annually per family for secondary and tertiary care hospitalisation at both public and private-empanelled healthcare providers.
Despite the scheme being aggressively utilised as a political tool, its fundamental principles struggled to bear the burden. Hence, in March, the Union government formed a panel to evaluate the scheme, review its design and implementation, and suggest modifications. The panel has submitted its report to NHA and deliberations are going on with states, according to two official sources privy to the development.
“The scheme, in its current form, could not take the load of expansion. The report suggests several modifications. We have discussed around a dozen models to include the additional elderly base,” one of the officials told News18.
With the inclusion of a new set of beneficiaries, constituting approximately 10 per cent of India’s total population, the Modi government’s scheme is set to officially cover 50 per cent of the population — at least on paper.
Moreover, the Centre administers several other health insurance schemes such as the Central Government Health Scheme or CGHS, the Ex-Serviceman Contributory Health Scheme or ECHS and the Employee State Insurance or the ESI, collectively covering an additional 10 per cent of the population. With this expansion, the Modi government will end up extending health insurance coverage to three-fifths or 60 per cent of the country’s population.
More Than 12 Models Under Consideration
While more than 12 models are being studied to expand the beneficiary base of the scheme, the government is likely to add aged beneficiaries using the simple and ongoing method, one of the sources quoted above indicated.
They can be added either under a trust mode (where the state implements the scheme without an insurance company), an insurance mode (where an insurance company manages the scheme), or a hybrid mode that combines aspects of both.
“The NHA is also looking at increasing the cost of packages that are paid to hospitals, which is one the biggest concerns of private hospitals. With the addition of the elderly age group, geriatric packages will also be added. In this case, hospitals will be happy,” said the second source.
They added: “Also, the Centre will soon launch the health claims exchange platform, helping hospitals and insurance firms to run their business smoothly without any pendency from the government’s end.”
Before I conclude, here is a caveat. If you read the numbers carefully, while on paper the scheme covers 40 per cent or 55 crore Indians at present, the cards have been issued to just 60 per cent of these beneficiaries. This suggests that the missing beneficiaries, whom the NHA has been attempting to locate, either do not exist (possibly due to outdated data ie Socio-Economic and Caste Census (SECC) 2011 used in creating the beneficiary list) or are unaware of the existence of such a scheme to aid them.
Ultimately, the fate of the scheme now rests with the Finance Ministry. Each official I speak to consistently concludes that the allocation of health budgets will determine the execution of the scheme and will indicate how ambitious India can be.
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