Over two lakh beneficiaries have availed hospitalization benefits worth ₹300 crore in the first 51-days of the Pradhan Mantri Jan Arogya Yojana (PMJAY), which offers ₹5-lakh-a-year free health cover to 10.7 crore households. Going by the initial trend, the average hospitalization cost per person works out to be around ₹15,000, higher than ₹10,000 estimated by the NITI Aayog. However, this is too early to gauge the long-term average hospitalization cost under the scheme. “Over 5 lakh e-cards have been distributed and 33 states/UTs have joined the scheme,” the National Health Agency, which administers PMJAY, said in a tweet. Bulk of the beneficiaries are from Chhattisgarh, Gujarat, Maharashtra, Madhya Pradesh, Uttar Pradesh, Tamil Nadu, and Assam, an official said. The cost of the healthcare benefits is across three models under implementation for PMJAY: trust, insurance and hybrid (mix of insurance and trust models).
Of 33 states/Union territories, which are on board for the scheme, 18 are under trust model with costs covered by the Center and states from the corpus created from the contribution by the Center and states. Only seven are under the insurance mode, while eight are under a hybrid model where part of the cover is under the insurance model and the rest under the trust model. The average hospitalization was about 4000 per day after the scheme was rolled out on September 23. Ayushman Bharat CEO Indu Bhushan recently said that about 25 lakh could benefit from free hospitalization by the end of March 2019. Hospitalization rate would further rise to 1 lakh/day when beneficiaries from under-served states Uttar Pradesh, Bihar, and Madhya Pradesh, which account for one-third of India’s population, fully access the scheme.
According to sources, the Center and states have capped (on ad-hoc basis) their combined annual premium outgo for the ambitious scheme at around ₹1110/family. Under the scheme, free health cover is to be given to 10.7 crore households, or about 50 crore people. The annual premium cost, now seen at around ₹11,000 crore, will be shared in a 6:4 ratio between the Center and states. The cost of the scheme would be much lower in FY19, as half of the year is over and some populous northern states implementing such a scheme for the first time would take time to fully roll it out. – Financial Express