The PM Jan Arogya Yojana (PMJAY) is the world’s largest health insurance scheme that aims at providing quality healthcare facilities to the underprivileged families across the country. This insurance scheme, that covers both pre and post hospitalization cost, is expected to benefit approximately 10 crore families across the nation. As a part of this scheme, families belonging to the financially weaker section can avail a health cover of Rs. 5 lakhs per annum.
However, it is to be noted that the PMJAY scheme hasn’t led to any reduction in the Out of Pocket (OOP) expenses of the beneficiaries. A major portion of OOP expenditure is on outpatient care that is not covered under the PMJAY scheme. Since the beneficiaries belong to the financially deprived section, they largely seek outpatient care to avoid losing their daily earnings.
Proper execution of the PM Jan ArogyaYojana requires ample resources. The National Health Agency (NHA), had reportedly demanded Rs 7,400 crore to meet the expenses of the PMJAY scheme for 2019-2020 but has been provided only Rs 6,400 crore. This has led to apprehensions regarding last-mile delivery of services to the patients.
This euphoria about the PMJAY scheme is in contrast with the apathetic treatment provided to public health schemes such as the National Health Mission (NHM). It has been observed that the share of NHM in the total health budget has declined since 2014-15 from 61 percent to 49 percent in 2019-20.
Despite the various tax claims, the union government’s budgetary allocation for the health sector has remained stagnant at about 0.3 percent of GDP since 2014-15.
Thus, this has resulted in the weakening of the public health system. The allocation for PMJAY increased drastically by 167 percent while those for National Rural Health Mission (NRHM) increased by a mere 2 percent. Whereas over the duration of 2017-18, the NRHM allocation declined by 1.5 percent. Moreover, the allocation for the second component of Ayushman Bharat — the Health and Wellness Centres (HWCs) budgetary provisions have been put under the NHM head. This implies that allocation to HWCs would come at the cost of existing interventions under the NHM.
In addition to the incentives provided under the PMJAY, the private sector has been given an increasing role in managing primary healthcare. Moreover, the regulation of the private sector is negligible and only a few states follow the Clinical Establishment Act. All these factors have contributed towards undermining the public health system and promoting a privatized healthcare model.
Thus PMJAY can prove to be a revolutionary scheme in the health sector providing beneficiaries with essential health insurance benefits.