The AB-PMJAY SEHAT scheme in Jammu and Kashmir has proven to be a tremendous benefit to the public. Since its launch in December 2020, over 5.50 lakh patients have received treatment, amounting to nearly Rs. 1,225 Crores in healthcare expenses covered.
This initiative, under the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana SEHAT (AB PM-JAY SEHAT) scheme, aims to provide Universal Health Coverage to all the residents of Jammu and Kashmir. Launched by the Hon’ble Prime Minister of India on December 26, 2020, it offers an annual health cover of Rs. 5 lakhs per family for secondary and tertiary care hospitalization across both public and private empanelled hospitals in India.
Remarkably, Jammu and Kashmir is the only state or UT in India to implement such a comprehensive scheme, ensuring healthcare access for all residents, regardless of their socio-economic status. The UT boasts a total of 235 empanelled hospitals, both public and private, under the scheme. Additionally, national portability enables beneficiaries to receive treatment at nearly 28,000 empanelled hospitals across the country.
The Government of Jammu and Kashmir has diligently followed the guidelines of the National Health Authority (NHA), Government of India, for the scheme’s implementation. This includes using the Model Tender Document issued by NHA for transparent selection of insurance companies and adopting Health Benefits Packages (2.2 version) for implementation. The IT solutions developed by the National Health Authority are integral to the scheme’s operation.
Since the launch of AB PM-JAY SEHAT scheme, the Government of J&K has paid Rs. 982.59 Crores in premiums to insurance companies. In return, insurance companies have disbursed a total of Rs. 1,226.68 Crores in claims to empanelled hospitals (Rs. 638.81 Crores to public hospitals and Rs. 587.87 Crores to private hospitals) for the treatment of beneficiaries. A total of around 5.50 lakh patients have availed treatment for various conditions under the scheme which, inter-alia, include 20,940 Cancer patients (amounting to Rs. 171.01 Crores), 19,177 patients with Cardiac ailments (amounting to Rs. 160.87 Crores) and 9,710 patients suffering from Chronic Kidney Diseases (amounting to Rs. 90.57 Crores). In the absence of such a scheme, most of the patients suffering from these Life Consuming and Life Threatening diseases could not have afforded such treatments which required prolonged medical management.
The scheme’s insurance model shifts the risk to insurance companies, as evidenced by them paying nearly Rs. 244 Crores beyond the premiums to the empanelled public and private hospitals. This model has not only strengthened the healthcare system within the UT but has also significantly reduced out-of-pocket expenses, preventing catastrophic payments and poverty for families in need of hospitalization. It has also positively impacted the health-seeking behavior and satisfaction of beneficiaries, creating employment opportunities in both government and private hospitals.
For enhanced patient satisfaction, a feedback system using QR codes and a 104 Call Centre has been implemented. Impressively, nearly 99% of patients providing feedback have rated their treatment experience as Excellent or Good.
However, it’s worth noting that there have been attempts to discredit the scheme through misinformation. Such allegations are intended to disrupt the services and shall be dealt with strictly.
