6 crore hospital admissions costing Rs 77,298 cr authorised under AB PM-JAY till Nov 30: Govt to LS

The AB PM-JAY is the largest publicly funded health assurance scheme in the world which aims to provide health cover of Rs 5 lakh per family yearly for secondary and tertiary care hospitalization to 12 crore families, Union Health Minister Mansukh Mandaviya said.

New Delhi: Approximately six crore hospital admissions entailing an expenditure of Rs 77,298 crore have been authorised under the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana till November 30, Union Health Minister Mansukh Mandaviya told Lok Sabha on Friday.

As of December 2, a total of 26,774 hospitals, including 11,733 private facilities, across the country have been empanelled to provide healthcare services to the scheme beneficiaries, he said, adding that 4.98 crore claims have been submitted between financial years 2020-21 and 2023-24 as of November 30.

The AB PM-JAY is the largest publicly funded health assurance scheme in the world which aims to provide health cover of Rs 5 lakh per family yearly for secondary and tertiary care hospitalization to 12 crore families, the minister said.

He said AB PM-JAY provides health cover to families which constitute the bottom 40 per cent of the population. The budget allocated for Ayushman Bharat PM-JAY for the financial year 2023-24 is Rs 7,200 crore, he said.

"With respect to utilization, it may kindly be noted that as of November 30, 2023, approximately, six crore hospital admissions worth Rs 77,298 crore have been authorised under the scheme," he said.

The AB PM-JAY scheme is completely cashless and paperless and without the concept of reimbursement. Beneficiaries can avail treatment under defined packages. 

The Empanelled Healthcare Providers are paid based on specified health benefit packages with standardised rates.

As per the latest health benefit packages (2022), a total of 1,949 procedures across 27 specialities are available for AB PM-JAY beneficiaries. Further, states and Union Territories have been given the flexibility to add state-specific packages over and above the national master.

Also, they have been provided flexibility to change the cost of the package as per local requirements. The scheme provides treatment corresponding to a total of 1,949 procedures under 27 different specialities, including diseases such as cancer, diabetes and heart ailments. 

Leprosy as a package is not included under PM-JAY. However, 26 procedures related to skin diseases and 549 procedures related to cancer are covered under AB PM-JAY. 

"Further, to ensure that AB PM-JAY beneficiaries are not denied care for treatments/procedures that do not feature in the health benefit packages, one unspecified package has been included in it to avail treatment for such procedures under the scheme."

"Approximately 34.92 lakh hospital admissions worth Rs 6,537 crore and 1.68 lakh hospital admissions worth Rs 254 crore have been authorized as of December 2, 2023, under Ayushman Bharat PM-JAY for cancer-related treatment and skin-related treatment respectively," Mandaviya stated.