Centre likely to integrate all health schemes under AB-PMJAY

The Centre’s flagship health insurance scheme, the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY), is gradually shaping up as the umbrella scheme for all health schemes in the country, with many central government ones already aligned, and talks on for several others. What’s more, the AB-PMJAY coverage is also likely to be doubled to Rs 10 lakh in days to come.

Major central government health schemes like the Employees’ State Insurance Scheme (ESIS) and the Central Government Health Services (CGHS) have already been aligned with the PMJAY. And discussions are on to align others like the Building and Other Construction Workers (BoCW) and Ex-Servicemen Contributory Health Scheme (ECHS), besides several existing state government health schemes.

Sources close to the development told Business Standard that discussions were on to link ECHS with AB-PMJAY. “Nothing concrete has been decided yet, but discussions are definitely on,” said a source who did not wish to be named. The linking of BoCW with AB-PMJAY has also started, the source added. “This will be led by the state governments.”

As many as 157 districts have started work to onboard ESIS beneficiaries on the platform of the National Health Authority (NHA), the apex body responsible for implementing the PMJAY, said the source quoted above. The NHA could not be reached for a comment.

The NHA has been entrusted with designing a strategy, building technological infrastructure, and implementing the National Digital Health Mission to create a National Digital Health Ecosystem.

The Employees’ State Insurance Corporation (ESIC) had in 2021 entered into a partnership with the NHA to create an ecosystem where ESI beneficiaries might access services at hospitals empanelled with the AB-PMJAY, and vice versa. “This move was aimed at creating demand for health services at the underutilised ESIC-empanelled hospitals. And it also gave ESI beneficiaries access to AB-PMJAY-empanelled hospitals for surgical procedures,” said an industry insider asking not to be named.

In the initial phase, a pilot was conducted in Maharashtra’s Ahmednagar and Karnataka’s Bidar, under which ESI beneficiaries of these districts got access to medical care services in PMJAY-empanelled hospitals. This has now been scaled up to 157 districts.

“The Centre is working towards making AB-PMJAY the umbrella scheme for converging the different health schemes available in the country. The idea is to move towards a universal health scheme on the lines of the US. The process has begun. Health coverage can be extended to almost 70-75 per cent of the population very easily through this,” said the owner of a Delhi-based hospital network who works with the AB-PMJAY scheme.

Meanwhile, in a move to integrate various government health schemes under the Ayushman Bharat Digital Mission, the Ministry of Health and Family Welfare earlier this month mandated the linking of CGHS beneficiary ID with the Ayushman Bharat Health Account (ABHA) ID. The linking of the IDs is mandatory from April 1, 2024, and it is to be completed within 30 days by all existing CGHS beneficiaries. More than 4.4 million people in 75 cities are covered under the CGHS scheme, which provides comprehensive health care services to central government employees, pensioners, and their dependent family members. Of them, the CGHS IDs of 126,707 had already been linked with ABHA IDs as on April 21, according to information available on the CGHS dashboard.

The ABHA ID is a 14-digit number that uniquely identifies a beneficiary in India’s digital health care ecosystem. All citizens can open and operate ABHA accounts.

In another significant move, states like Haryana, Uttar Pradesh, Uttarakhand and Nagaland have started linking their state health insurance schemes with AB-PMJAY, according to a government source. “This would be led by state governments and these beneficiaries will also be issued Ayushman Bharat cards.”

In the interim Budget for 2024-25, the Centre announced that more than 3 million Accredited Social Health Activist (ASHA) and anganwadi workers and helpers would also be covered under the AB-PMJAY scheme.

So far, 342 million AB-PMJAY cards have been issued since the scheme was launched in September 2018, covering more than 65 million hospitalisations across more than 30,000 empanelled hospitals across the country.

A government source also indicated that discussions were on to raise the ceiling of Rs 5 lakh for AB-PMJAY beneficiaries to Rs 10 lakh. “A proposal has been sent (to the finance ministry) in this regard. But nothing is concrete yet. This would require the scheme allocation to be almost doubled,” said a source.

The AB-PMJAY was allocated Rs 7,200 crore in 2023-24, and this was raised only marginally to Rs 7,500 crore in the interim Budget presented in February.

Widening the coverage

• Rs 5 lakh: Annual coverage under AB-PMJAY for secondary- and tertiary-care hospitalisation for poor and vulnerable families, which form the bottom 40% of the Indian population
• ESIS, CGHS: Among the several central govt schemes getting linked with AB-PMJAY
• BoCW: States will lead the linking of the Building and Other Construction Workers health schemes with AB-PMJAY
• ECHS: Discussions are on to link the Ex-Servicemen Contributory Health Scheme with AB-PMJAY
• Haryana, UP: Among states where govt health schemes are getting merged with AB-PMJAY
• 342 mn: Ayushman Bharat cards issued so far since 2018
• 65 mn: Hospitalisations covered so far

Business Standard