Govt may double AB-PMJAY beneficiaries, insurance amount

The Indian government is considering significant enhancements to the Ayushman Bharat health insurance scheme, aiming to double the number of beneficiaries and increase the insurance coverage. Here are the key points:

Proposed Changes

  1. Doubling the Beneficiary Base:
    • The government plans to expand the beneficiary base over the next three years.
    • Initially, all individuals above 70 years old will be included.
    • This expansion will cover more than two-thirds of the Indian population.
  2. Increased Insurance Coverage:
    • The insurance coverage amount is proposed to increase from Rs 5 lakh to Rs 10 lakh per year.
    • This is to account for inflation and to help cover high-cost treatments like transplants and cancer.
  3. Financial Implications:
    • The estimated additional expenditure for these changes is Rs 12,076 crore per annum.
    • The National Health Authority has prepared these estimates.

Expected Announcements

AB-PMJAY beneficiaries

  • Some of these proposals might be announced in the upcoming Union Budget.
  • The interim Budget 2024 increased the allocation for AB-PMJAY to Rs 7,200 crore and allocated Rs 646 crore for the Ayushman Bharat Health Infrastructure Mission (PM-ABHIM).

Coverage Expansion Details

  • President Droupadi Murmu announced that all individuals above 70 years will receive free treatment under the Ayushman Bharat Yojana.
  • This will add approximately 4-5 crore more beneficiaries to the scheme.

Historical Context and Report Findings

  • The Rs 5 lakh coverage limit for AB-PMJAY was set in 2018.
  • The NITI Aayog’s 2021 report, “Health Insurance for India’s Missing Middle,” highlighted that about 30% of the population lacks health insurance.
  • The report suggested the need for a low-cost comprehensive health insurance product for the “missing middle,” which includes self-employed individuals in rural and urban areas who are not covered by existing schemes.

Current Insurance Landscape

  • AB-PMJAY and state government extension schemes currently provide hospitalization cover to the bottom 50% of the population.
  • Around 20% of the population is covered by social health insurance and private voluntary health insurance.
  • The remaining 30%, termed the “missing middle,” is largely uncovered due to gaps in the existing insurance schemes.

Implications of the Changes

  • The proposed changes aim to provide better financial protection for health, especially for high-cost medical treatments.
  • These efforts are part of the government’s broader goal of achieving Universal Health Coverage.

Conclusion

The proposed enhancements to the Ayushman Bharat scheme reflect the government’s commitment to expanding healthcare access and reducing the financial burden of medical expenses on families. The focus on including elderly individuals and increasing the coverage limit aims to address the healthcare needs of the most vulnerable populations.

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