SRINAGAR: The AB PM-JAY SEHAT scheme in Jammu and Kashmir has proven highly advantageous to the public since its launch in December 2020. Over 5.50 lakh patients have received treatment, with healthcare expenses amounting to nearly Rs 1,225 Crores being covered.
This initiative, part of the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana SEHAT (AB PM-JAY SEHAT) scheme, aims to provide Universal Health Coverage to all Jammu and Kashmir residents. Launched by the 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 hospitalisation in both public and private empanelled hospitals across India.
Notably, Jammu and Kashmir stands as the sole state or UT in India implementing such a scheme, ensuring healthcare access for all residents, regardless of their socio-economic status.
There are a total of 235 empanelled hospitals, encompassing both public and private facilities, under the scheme. Additionally, beneficiaries can access treatment at approximately 28,000 empanelled hospitals nationwide due to national portability.
The Government of Jammu and Kashmir has adopted the Model Tender Document issued by NHA for transparent selection of insurance companies and utilising Health Benefits Packages (2.2 version) for implementation. The scheme’s operation relies on IT solutions developed by the National Health Authority.
Since the AB PM-JAY SEHAT scheme’s launch, the Government of J&K has disbursed Rs 982.59 Crores in premiums to insurance companies. In return, insurance companies have paid out 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 beneficiary treatment.
Approximately 5.50 lakh patients have received treatment for various conditions under the scheme, including 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 with Chronic Kidney Diseases (amounting to Rs 90.57 Crores).
The scheme’s insurance model transfers risk to insurance companies, evident in their payment of nearly Rs 244 Crores beyond premiums to empanelled public and private hospitals.
To enhance patient satisfaction, a feedback system employing QR codes and a 104 Call Centre has been implemented. Impressively, nearly 99 percent of patients providing feedback have rated their treatment experience as Excellent or Good.
