1. Ayushman Bharat –Pradhan Mantri
Jan Aarogya Yojana (AB-PMJAY)
Md Mostaque Ahmed
PGT
Department of Community Medicine
GMCH, Guwahati
2. Background of Ayushman Bharat
Ayushman Bharat is an attempt to move from sectoral and segmented
approach of health service delivery to a comprehensive need-based
health care service.
• About 86% of rural households and 82% of urban households do not
have access to healthcare insurance.
• Over 17% of the country’s population spend a minimum of 1/10th of
their household budgets on availing health services.
• Unexpected and serious healthcare problems often lead families to
debt.
• Over 19% and over 24% of the urban and rural households
respectively meet their healthcare financial needs through borrowings.
3. Ayushman Bharat PM-JAY
• This was launched in September 2018 by the Ministry of Health and
Family Welfare
• A scheme of GOI to provide free access to healthcare for 40% of
India’s population.
• Provides Secondary and Tertiary Health Care Services
• It became the World’s Largest Government sponsored healthcare
program
4. Secondary Health Care
-Serious illness/injury
-Child Birth
-Hospital Care
-Therapists
-Psychologists
Tertiary Health Care
-Advanced medical treatment
- Cancers
- Complex medical intervention
6. Some features of the scheme
- Coverage of Rs.5 lakh per family per annum for secondary and tertiary
care across public and private hospitals.
- Approximately 50 crore beneficiaries (over 10 crore poor and
vulnerable entitled families) are eligible for the scheme.
- Covers up to 3 days of pre-hospitalization and up to 15 days of post-
hospitalization expenses such as medicines and diagnostics.
- Includes costs for diagnostic services, drugs, room charges, physician’s
fees, surgeon charges, supplies, ICU and OT charges.
- No restriction on the family size, gender or age.
- The scheme includes 1,393 medical procedures.
7. Diseases which are covered
- Prostate cancer.
- Double valve replacement.
- Coronary artery bypass graft.
- COVID-19.
- Pulmonary valve replacement.
- Skull base surgery.
- Anterior spine fixation.
- Laryngopharyngectomy with gastric pull-up
- Tissue expander for disfigurement following burns.
8. Diseases which are not covered
• Out-Patient Department (OPD) expenses.
• Drug rehabilitation.
• Cosmetic surgeries.
• Fertility treatments
• Individual diagnostics.
• Organ transplant.
9. Benefits
- Will reduce medical expenditure for many families
- Beneficiary families are said to have saved over
Rs.13000 crores.
- Over 60% of the treatments have been done by private
hospitals
- In 2018, it generated more than 50000 jobs
- Economically weaker sections of society can have
access to quality healthcare services without financial
hardships.
10. Who all are not eligible for AB PM-JAY
- Those who have mechanized farming equipwheele
- Who owns a two, three or four- wheeler.
- those who hold a Kisan card.
- Government employees.
- Those who own a motorized fishing boat.
- Those who are earning more than Rs.10,000 per month.
- Those who own more than 5 acres of agricultural land.
- Those who own landline phones or refrigerators.
- Those who live in decently built houses.
