For about 53 crore poor and vulnerable beneficiaries, testing and treatment for COVID-19 is free of cost under PM-JAY

On May 20, Prime Minister Narendra Modi said that every Indian should be proud that Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (PM-JAY) has crossed one crore treatments, and has had a positive impact on many lives.

The poor and vulnerable beneficiaries of PM-JAY have been from both urban and rural locations in India. Pooja Thapa, the one crore-th beneficiary, a housewife with two small children, and a husband serving in the army, is from Meghalaya, and she got her treatment in a Shillong hospital. During her interactions with PM Modi, she thanked him and said that she underwent free surgery including free medicines, and is on the road to recovery.

PM-JAY is a giant step towards a healthy India, as it aims to make affordable, accessible healthcare a reality for all. PM-JAY has crossed a significant milestone of one crore hospitalisations, worth over Rs. 13,412 crore, in less than 20 months since its launch on September 23, 2018.

Delivering one crore free and cashless treatments in this time period shows that there was a lot of demand and people needed a scheme like PM-JAY. The efforts of the doctors, nurses, healthcare workers, para medical staff and all others associated with Ayushman Bharat, across all states, have helped in making it the largest healthcare programme in the world.

As PM-JAY marks this milestone of one crore treatments, the whole world including India faces the COVID-19 pandemic. The impact on millions worldwide and in India is not only pertaining to health, but there is also the physical, mental, economic impact on the individual and his family.

For about 53 crore poor and vulnerable beneficiaries, testing and treatment for COVID-19 is free of cost under PM-JAY, including testing in private labs and treatment in private hospitals. Overall, PM-JAY provides a cover of up to Rs. 5 lakh per family per year, for secondary and tertiary care hospitalisation to the eligible beneficiaries.

In India, the migrant population plays a key role in the economic development of the country, and they are ones facing a large brunt of the pandemic crisis. A key design feature of PM-JAY from the beginning of the scheme is portability, which helps to ensure that a PM-JAY-eligible migrant worker can access the scheme’s services in any empanelled hospital across the country, irrespective of their state of residence.

The PM-JAY eligible migrant can avail of the scheme’s benefits in the state in which he works, and also in his home state, when he goes back home. This lowers the barriers posed by state borders and promotes equal access to quality health services, especially amongst the poor and vulnerable population.

No empanelled hospital across the country can deny treatment to any PM-JAY beneficiary. To date, there have been more than one lakh portability cases, a high percentage of portability cases (by volume) are for tertiary care, and availed by men. Implementing portability is extremely complex and many countries which have a health assurance scheme did not start with portability from the beginning. The strong IT backbone of PM-JAY was crucial to the implementation of portability from the beginning of the scheme in India.

The aim of Ayushman Bharat is to ensure the achievement of universal health coverage in India. Gujarat, Tamil Nadu, Chhattisgarh, Kerala, and Rajasthan have emerged as the top performing states providing the highest number of treatments under the scheme.

Orthopaedics, Cardiology, Cardio-thoracic and Vascular surgery, Radiation Oncology and Urology have remained as the top specialties under which treatment is sought. Treatment packages — such as single stent (medicated, inclusive of diagnostic angiogram), hip fracture internal fixation and rehabilitation, Coronary Artery Bypass Grafting (CABG), double stent (medicated, inclusive of diagnostic angiogram) and Total Knee Replacement — have emerged as top tertiary procedures.

The National Health Authority (NHA) has been working on new initiatives to support and supplement the Government of India’s efforts in its response to the COVID-19 pandemic. From a supply side, PM-JAY has further strengthened the network of hospitals and service capabilities to ensure continued service delivery to non COVID-19 patients while also providing services for COVID-19 patients.

This is being done through an express empanelment mechanism for hospitals since March this year. Since April 1, 2020, more than 1,385 hospitals (nearly 58 per cent are private hospitals) have been empanelled across the country out of which 75 are under express empanelment. Overall, 21,565 hospitals have been empaneled so far.

The NHA has leveraged its IT systems, expertise and the network of private sector stakeholders to support the government’s preparedness and response: This has been done by managing the national COVID-19 helpline 1075 and conducting thousands of outbound calls to COVID-19 positive patients, and their families, round the clock.

The NHA has made calls to disseminate precaution advisories to relevant beneficiaries of PM-JAY. This gathered data will also be used to strengthen the government’s efforts at identifying such potential cases and ensure optimal utilisation of testing facilities and resources.

The NHA regularly keeps in touch with the relevant beneficiaries through telephone, and three crore such calls have been made across the country already. Further, the NHA is also supporting the government’s Arogya Setu mobile application. It has been making outbound calls through its call centre to people who have come in close proximity to COVID-19 positive patients, as identified through the app, and people who have reported COVID-19-like symptoms in their self-assessment.

The NHA has, already, contacted more than six lakh citizens; and facilitated more than 15,000 tele-consultations with doctors. It is also working with the ICMR on data cleansing and is conducting call data analysis for flagging urgent actionable cases being sent to ICMR.

In any epidemic, the response has to be a collective societal one — as seen during SARS, Ebola, H1N1. Public sector, private sector, NGOs, all have to come together. The response to this pandemic is being led by the government; however, the private sector needs to become an active partner, especially regarding the provision of an adequate supply of health services, medicines and essentials.

The NHA has focused on how to get the private sector more actively involved in the official response with greater participation from private sector hospitals for both COVID-19 as well as non-COVID-19 health conditions. Various states are adopting different approaches for involving the private sector in the treatment.

Coronavirus will be a part of our lives for a very long time. Our fight against COVID-19 is, therefore, not a sprint, it is a marathon. We will do whatever needs to be done, but, as PM Modi said, Bharat will move ahead towards being “atma-nirbhar”, even as we turn this adversity into opportunity. Living in a post COVID-19 world will be vastly different from before, and will require vastly different public health approaches.

As we plan for the future, Indians who require secondary and tertiary care will continue to grow, and we must also leverage the promise of telemedicine for preventive health. From a supply side, we must focus on strengthening medical and health systems, primary health care delivery and healthcare workforce — including specialist doctors and medical professionals.

Ayushman Bharat PM-JAY will continue to play a stellar role in this post-COVID-19 world, in improving the overall healthcare in the country. The one crore treatment milestone is only the beginning. Our vision is to provide more than one crore treatments every year, year-on-year, so that the poor and needy can get the best healthcare: So that they too are able to contribute to the overall economic progress of India, in this post-COVID-19 period.