Bhubaneswar: Odisha is gearing up to join the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB PM-JAY), one of India’s most ambitious health insurance initiatives. This move will provide health coverage of up to ₹5 lakh annually for every eligible family in the state, significantly improving access to secondary and tertiary care. The decision, now in advanced stages of discussion, will align the state’s own health scheme with this central flagship program, promising enhanced medical benefits for millions of Odias.
What is the Ayushman Bharat PM-JAY Scheme?
Launched in 2018, the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (PM-JAY) is the world’s largest publicly funded healthcare scheme. It aims to provide quality healthcare services free of cost to vulnerable families across India. Under the scheme, over 10 crore families across the country are eligible to receive free treatment for up to ₹5 lakh per year in empanelled hospitals, covering almost 1,950 medical procedures.
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The scheme has been a boon for the economically weaker sections, offering comprehensive care that includes surgeries, treatments, and post-hospitalization services like medications for 15 days, diagnostics, and even food and lodging during hospital stays.
Odisha’s Decision: A Significant Move in Healthcare
Odisha, one of the few states that had not yet implemented the PM-JAY scheme, has now decided to come on board. Alongside Delhi and West Bengal, the state had previously opted out, preferring to focus on its state-run health insurance programs. However, the impending inclusion of Odisha is being seen as a progressive step toward ensuring affordable healthcare access for all.
According to sources close to the discussions, the technical aspects of integrating Odisha’s existing state health scheme with the Ayushman Bharat PM-JAY are being worked out. Once finalized, the state will run both schemes in tandem, allowing beneficiaries to avail benefits from both programs where applicable.
Sharing the Financial Burden: Centre and State Partnership
Like in other states, the financial responsibilities for the implementation of the Ayushman Bharat scheme in Odisha will be shared between the state and the central government. The central government typically bears 60% of the financial load, with the state covering the remaining 40%. This collaborative effort ensures that the scheme is sustainable and reaches every eligible citizen.
The entry of Odisha into the Ayushman Bharat framework is expected to be seamless. However, there have been some delays in other states due to administrative hurdles, such as Punjab, which hasn't posted its audit reports from 2019-2020 onwards. Odisha is working to avoid such delays and ensure a smooth implementation.
Health Coverage Expansion for Senior Citizens
One of the recent and most notable changes in the PM-JAY scheme is the extension of benefits to all individuals aged 70 years and above, irrespective of their income. This policy shift ensures that the elderly population, which is particularly vulnerable to health complications, is well-protected.
This expanded coverage is expected to benefit approximately 6 crore citizens nationwide, including 4.5 crore households. Odisha, once fully integrated into the scheme, will witness a significant improvement in the healthcare access of its senior citizens.
Empanelment of Hospitals: Ensuring Access to Quality Care
Till September 1, 2024, a total of 29,648 hospitals have been empanelled under the PM-JAY scheme across India, including 12,696 private hospitals. These hospitals are strategically located to ensure maximum reach, and Odisha will soon be adding its hospitals to this list, ensuring that people from the state have access to a wide network of healthcare providers.
The empanelled hospitals offer a range of services, from general medicine and surgery to specialized care in fields like oncology and cardiology. Beneficiaries will not have to worry about the cost of treatments, medications, or diagnostics for up to three days prior to admission and 15 days post-discharge.
Women’s Participation in the Scheme
Women constitute a substantial proportion of the beneficiaries under the Ayushman Bharat scheme. As of September 2024, approximately 49% of the Ayushman Bharat cards have been issued to women. Of the 7.79 crore hospital admissions under the scheme, nearly 3.61 crore are utilized by women. This highlights the scheme’s role in supporting women’s healthcare needs, and Odisha’s participation will likely further enhance women’s access to critical medical services.
October 2024: A Major Milestone for the Expanded Scheme
The expanded version of the Ayushman Bharat PM-JAY scheme is set to roll out from October 2024, bringing with it a host of new benefits. A unique feature of this expansion is the introduction of a special card to distinguish between Ayushman Bharat family beneficiaries and senior citizens. This distinction will help in targeted healthcare service delivery.
The Road Ahead for Odisha: Transforming Healthcare Access
The inclusion of Odisha into the Ayushman Bharat scheme will be a transformative step for healthcare in the state. With its population set to benefit from increased healthcare coverage, more comprehensive services, and better financial protection against catastrophic health expenses, Odisha’s citizens will have a safety net that could change the course of healthcare delivery in the state.
The state’s dual implementation of both its health scheme and Ayushman Bharat will ensure that there are no gaps in healthcare access, offering residents the best of both worlds. This move also aligns with the national vision of achieving Universal Health Coverage (UHC), a key goal outlined in India’s healthcare agenda.
As Odisha moves toward integrating with Ayushman Bharat, the state government’s collaboration with the Centre will be key to ensuring smooth implementation and reaching the widest possible audience. Given that the scheme is already active in 33 states and Union Territories, Odisha’s entry will be a significant milestone for the program.
Conclusion: A Healthier Future for Odisha
Odisha's decision to join the Ayushman Bharat scheme marks a pivotal moment for the state’s healthcare system. With an array of comprehensive healthcare services now set to be available to millions of families across the state, the future of healthcare access in Odisha looks brighter than ever. The alignment of the state’s own health scheme with Ayushman Bharat will ensure that citizens receive the best possible care without worrying about financial burdens. For the people of Odisha, this is indeed a game-changer.