States that rank higher in various economic and social parameters have benefited the most from the Pradhan Mantri Jan Arogya Yojana (PM-JAY) than the weaker ones, indicating that administrative agility and awareness among people impact the free health insurance scheme’s coverage.
The cost of PM-JAY, which offers Rs 50,000 per year free health cover to 107 million households in the country, is shared between the Centre and states in a 6:4 ratio.
According to data reviewed by FE, people from Tamil Nadu were the biggest beneficiaries among 33 States and Union territories that have implemented the PM-JAY. Till December 4, 2022, about 8.4 million people from the southern state, with an average per capita income of Rs 2,41,131 (against the national average of Rs 149,848) have availed themselves of hospitalisation benefits under the PM-JAY. Other top beneficiary states are Kerala, with about 4.6 million availing hospitalisation benefits, followed by Rajasthan (3.9 million) and Karanataka (3.5 million).
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On the other hand, only about 0.5 million people from Bihar got hospitalisation benefits under PM-JAY. Bihar has an average per capita income of just Rs 49,470, 80% lower than Tamil Nadu. Other states lagging in the use of the scheme include Assam (0.55 million), followed by Maharashtra (0.69 million) and Jharkhand (1.4 million). The dismal performance in Maharashtra is attributed by analysts to implementation issues. Launched on September 23, 2018, PM-JAY is the world’s largest insurance/assurance scheme. Currently, the scheme covers the bottom 40% population of the country, who are identified on the basis of select deprivation and occupational criteria in rural and urban areas, respectively, as per the socio-economic caste census (SECC) 2011.
“My experience in India and abroad shows that such schemes benefit more people from states which have better governance, people who are more educated and informed, and better healthcare facilities ,” Gautam Bhardwaj, co-founder of pinBox, a global pensionTech, said.
Also Read: Extend PM-JAY health cover to the “missing middle”: NK Singh
After PM-JAY was launched in September 2018, 41.8 million beneficiaries across the country have availed of free hospitalisation benefits worth Rs 48,900 crore till November-end, 2022.
Under PM-JAY, a total of 1,949 procedures are available for beneficiaries to get cashless treatment which includes all the costs related to treatment, medicines, supplies, diagnostic services, physician’s fees, room charges, surgeon charges, OT & ICU charges, etc.
The Centre may widen the coverage of its flagship PM-JAY to middle-class families to protect them from rising health-related expenditure shocks.
The scheme expenses for eligible beneficiaries are shared in a 6:4 ratio between the Centre and states. Out of the two models adopted for the scheme, most states operate under the trust model while a few states operate under an insurance model.