According to the Modi government, Ayushman Bharat – Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) provides health insurance coverage to the poor and vulnerable families across the country. The coverage provided under this scheme is of up to INR 5 lakhs per family per year. This cost will be shared amongst the centre and states in the ratio of 60:40.

The PMJAY scheme fundamentals are primarily based on the erstwhile Rashtriya Swasthya Bima Yojana (RSBY). The RSBY could not reduce the out of pocket (OOP) medical expenses incurred by the people across the country and thus could not fulfill its said purpose. 

As of today, five states – Delhi, Chhattisgarh, Odisha, Telangana, and West Bengal – have opted out of the PMJAY scheme. Those states functioning under the PMJAY scheme have reported quite a few issues related to the same. Some of these issues include funds not disbursed on time, an increase in the last-minute treatments of the patients under the scheme, etc.

Also, the resources expected by the National Health Agency (NHA) are up to INR 7400 crore to meet the expectations for 2019-20. However, only INR 6400 crore has been allocated. The government has further promised to provide other facilities like land to private incentive investment in tier 2 and tier 3 towns. 

On the other hand, the National Health Mission has been on a consistent decline since 2014 and has reduced to 49% in 2019-20. There were high claims by the government towards efficiently regulating the budget of the health sector. This remains a long lost dream as the section is quite stagnant at 0.3 percent of GDP since 2014-15.

Over the years, there has been a deliberate decline in the public health system. So, when comparing the budget allocation for the PMJAY scheme with the National Rural Health Mission (NRHM), the difference is evident. The allocation of resources towards PMJAY increased by 167%, while the NRHM saw an increase of a mere 2%. 

Such a negligible distribution of budgetary resources have been observed, especially when the public health sector is on a decline. The overall healthcare infrastructure is weak across the country. And the same has been highlighted by the CAG report in its audit of NRHM.

Moreover, there is also a decrease in the healthcare workforce, while there is enormous work pressure to manage. The chief support of primary health care, the ASHA, and Anganwadi workers have been seeking regularisation and status as workers. Still, the government has been turning a blind eye towards their demands.

To Sum It Up!

In 2020, the only hope is that every household in this country has access to basic healthcare facilities. As of now, the AB-PMJAY scheme has said to benefit over 10 crore families across the country (approx. 50 crore individuals).

To avail the benefits of the PMJAY scheme, you have to first check if you are eligible for it. If your family is eligible, then you can move ahead for Ayushman Bharat Yojana registration. After successful registration, you and your family can avail the benefits under the program.

Taking all of this into consideration, it goes without saying that health insurance is a basic necessity, and every family in India should have one under their name. Even though you do not fall under the PMJAY scheme, make sure that you have adequate medical coverage for yourself and your loved ones.

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