Ayushman Bharat scheme vs. other medical insurance schemes

In 2018, the Indian government launched the Pradhan Mantri Jan Arogya Yojana (PMJAY), also known as the Ayushman Bharat scheme. This ambitious healthcare initiative aimed to provide financial protection and healthcare access to millions of vulnerable families across the country. While PMJAY represents a significant step towards universal health coverage, it’s essential to evaluate how it compares to other existing medical insurance schemes. In this article, you will examine the Ayushman Bharat scheme in depth and assess its strengths and weaknesses when compared to other insurance programs in India.

Ayushman Bharat scheme: A brief overview

The Ayushman Bharat scheme, often referred to as PMJAY, is the largest government-funded healthcare insurance program globally. It provides coverage to economically disadvantaged families, aiming to ensure that no one has to face financial hardships due to healthcare expenses. Key features of the scheme include:

  • Coverage: PMJAY covers hospitalisation expenses, including pre- and post-hospitalisation costs, making it one of the most extensive insurance programs.
  • Cashless treatment: Beneficiaries can access cashless treatment at empaneled hospitals, reducing the financial burden during emergencies.
  • Health package: The scheme offers over 1,300 medical and surgical packages, including critical illnesses, surgeries, and hospitalisation costs.
  • No upper limit: Unlike many private insurance policies, PMJAY does not have an upper limit on the expenses covered. This makes it a valuable resource for families facing significant medical bills.
  • Portability: Beneficiaries can access the scheme across India, making it suitable for people who need healthcare services outside their home state.
  • No premium: PMJAY is unique in that it does not require any premium payment from the beneficiaries. The government covers the entire cost, ensuring that even the poorest individuals can access quality healthcare.

Other medical insurance schemes in India

India has several other healthcare insurance programs, both public and private, that have been in existence before the Ayushman Bharat Scheme was launched. Some of the notable ones include:

  • Rashtriya Swasthya Bima Yojana (RSBY): RSBY, launched in 2008, aimed to provide health insurance to families below the poverty line. It primarily covered hospitalisation expenses and had a limited sum insured.
  • Employees’ State Insurance Scheme (ESIS): ESIS targets employees in the organised sector and provides medical and cash benefits. It covers hospitalisation, maternity, and other medical expenses.
  • Central Government Health Scheme (CGHS): CGHS serves government employees and pensioners, offering comprehensive medical coverage. It includes allopathic, homeopathic, and Ayurvedic treatments.
  • State-Specific Schemes: Several states in India have their healthcare insurance programs designed to cater to the specific needs of their residents. For instance, Tamil Nadu’s Chief Minister’s Comprehensive Health Insurance Scheme provides coverage for a wide range of medical services.

Comparing Ayushman Bharat scheme with other schemes

To evaluate the Ayushman Bharat scheme against other medical insurance schemes in India, you can consider several factors:

  • Coverage extent:

Ayushman Bharat scheme provides coverage for a more extensive population than many other schemes. It targets not just below the poverty line families but also those marginally above the poverty line, reducing the chances of vulnerable families falling into poverty due to healthcare expenses.

  • Benefit packages:

Ayushman Bharat scheme offers a wide array of medical and surgical packages, making it comprehensive in its coverage. Other schemes may have more limited benefits.

  • Portability:

Ayushman Bharat scheme’s portability allows beneficiaries to access healthcare services across the country. This is a crucial advantage for those who may need to travel for medical treatment.

  • No premium:

The absence of a premium in the Ayushman Bharat Scheme is a significant differentiator. Many other insurance schemes, both public and private, require beneficiaries to pay premiums, making them inaccessible to the poorest sections of society.

  • Financial protection:

PMJAY, by virtue of its extensive coverage and no upper limit on expenses, offers robust financial protection to its beneficiaries. Other schemes may leave individuals and families vulnerable to high out-of-pocket expenses.

  • Administrative efficiency:

Ayushman Bharat scheme employs technology for the verification of beneficiaries and claims processing, making it more efficient in terms of administrative procedures compared to some older schemes.

The Ayushman Bharat scheme, with its massive scale and ambitious goals, has the potential to significantly improve healthcare access and financial protection for vulnerable populations in India. It offers extensive coverage, no premium requirements, and portability, making it a valuable resource for millions of families. When compared to other medical insurance schemes, PMJAY stands out as a comprehensive and inclusive program that addresses the specific needs of economically disadvantaged individuals and families.

However, the success of the Ayushman Bharat scheme depends on efficient implementation, investment in health Insurance  infrastructure, and ongoing efforts to address challenges and criticisms. While it represents a major milestone in India’s journey towards universal health coverage, continuous evaluation and refinement are essential to ensure that it fulfills its promises and positively impacts the lives of millions of Indians.

mark harper

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