Pradhan Mantri Jan ArogyaYojana (PM-JAY), introduced under the ambit of Ayushman Bharat, aims to reduce the financial burden on poor and vulnerable groups arising out of catastrophic hospital episodes and ensure their access to quality health services was conceived.

        It will have offer a benefit cover of Rs. 500,000 per family per year data (approx. 50 crore beneficiaries). PM-JAY will cover medical and hospitalization expenses for almost all secondary care and most of tertiary care procedures.

Body:

The program certainly has a good intent of giving the best of the medical services at lowest prices to the economically weaker, deprived sections of the society. The program is fraught with many challenges that can hinder its outcome.

Finance: At about 1.3% of the national income, India’s public healthcare spending between 2008 and 2015, has virtually remained stagnant. It is a herculean task to implement a scheme that could potentially cost Rs 5 lakh per person and benefit 53.7 crore out of India’s 121 crore citizenry, or roughly about 44% of the country’s population. Because inflation in healthcare expenses has been known to increase faster than general inflation, the problem is likely to get worse in the future.

Doctor-Density Ratio: The WHO reports the doctor-density ratio in India at 8 per 10,000 people. To achieve such access, merely increasing the number of primary and secondary healthcare centres is not enough. Access should be equitable. Infrastructure creation and quantity of healthcare centres should go hand-in-hand.

Populist measures of the government: The idea of bringing the Above Poverty Line (APL) population in the unorganised sector under ambit of scheme has been a bone of contention. A sizeable part would remain uninsured—mostly lower-middle class and middle-class households whose income-earning members work in the unorganised sector. The high cost of insurance as compared to PMJAY would deter this section from being insured.

Lack of level playing field between the public and private hospitals: This has been a major concern as public hospitals would continue receiving budgetary support. This would dissuade the private players from actively participating in the scheme.

Additional incentives to the private players: The setting up hospitals in the underserved areas by private players can happen when there are incentives from the State. Lack of this would maintain status quo of last mile medical care which is in shackles.

Improper support infrastructure of IT: The programme is being rolled out hurriedly, even before the necessary systems and processes have been developed fully and tested for their robustness. This has led to continued Out of Pocket Expenditure for the poor pushing many into poverty.

Other Concerns:

• The crucial determinant of PMJAY’s success lies at the state government level as public health is a state subject.
• The experience from previous centrally-sponsored schemes is that line ministries have often created too many requirements and required excessive standardisation, thereby stressing on top-down approach.

Way Forward:

• The APL population need not be included immediately but, say, in a couple of years.
• Focus on health insurance penetration for the APL for time-beng.
• The budgetary support being granted to public hospitals can be given as incentives to private players in underserved areas.
• The National Health Authority set up as an independent authority should provide for less interference from the government, thereby encouraging private players to participate.
• A binding policy commitment is imperative so as to reduce policy uncertainty and enable investments in hospital infrastructure.

Conclusion:

PM-JAY seeks to accelerate India’s progress towards achievement of Universal Health Coverage (UHC) and Sustainable Development Goal – 3 (SDG3).