The Pradhan Mantri Jan Arogya Yojana (PM-JAY) contributed to improvement in many health outcomes in States that implemented the ambitious programme the Centre had launched more than two years ago to provide healthcare access to most vulnerable sections, according to the Economic Survey 2020-21.
“Though only a short time has elapsed since introduction, the effects identified by the Survey underscore the potential of the programme to significantly alter the health landscape in the country, especially for the vulnerable sections,” the Survey presented on Friday said.
The States that joined the PM-JAY, compared to those that did not, experienced greater penetration of health insurance, reduction in infant and child mortality rates, realised improved access and utilisation of family planning services and greater awareness of HIV/AIDS. This, the survey said, seeking to highlight initially the difference between West Bengal and its neighbours Bihar, Sikkim and Assam who adopted PM-JAY and later, comparing all States under the scheme and those that are not.
While some of the improvements stemmed directly from enhanced care enabled by insurance coverage, others represent spillover effects due to the same, the Survey said.
One of the largest health insurance/assurance schemes, fully financed by the government, PM-JAY provides healthcare of up to ₹5 lakh per family per year on a family floater basis. The Survey said it was being used significantly for high-frequency, low-cost care such as dialysis and continued to be utilised without disruption even during the pandemic and the lockdown. General care, which accounted for more than half the claims, exhibited a V-shaped recovery after falling during the lockdown, and reached pre-COVID-19 levels in December.
The Scheme, implemented by 32 States and Union Territories and in which 24,215 hospitals were empanelled, extended treatments worth ₹7,490 crore (with 1.55 crore hospital admissions). It enhanced health insurance coverage. Across all the States, the proportion of households with health insurance increased by 54% for States that implemented PM-JAY while falling by 10% in States that did not.
An analysis of claims under the scheme showed a long-tailed distribution that peaks in the range of ₹10,000-15,000. The highest number of pre-authorisation claims received were for procedures that cost amounts in this range. There were significantly fewer claims for more expensive procedures, the Survey said.
The claims for dialysis had not diminished due to COVID-19 or because of the lockdown in March-April 2020. They had only been growing. This highlighted the fact that the National Dialysis Mission could be merged with PM-JAY, the Survey said.