Context:
Recently, West Bengal has finally joined the flagship health insurance scheme Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) following the signing of an MoU between the state government and the National Health Authority.
About the Scheme:
Ayushman Bharat, launched in 2018 under the Ministry of Health and Family Welfare, is India’s flagship initiative aimed at achieving Universal Health Coverage in line with National Health Policy 2017 and Sustainable Development Goal 3 (Good Health and Well-being). It follows a “continuum of care” approach through four integrated pillars.
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- Ayushman Arogya Mandirs (AAM): Strengthens primary healthcare by upgrading sub-centres and PHCs into Health and Wellness Centres. It provides free medicines, diagnostics, maternal care, and screening for non-communicable diseases like diabetes, hypertension, and cancer.
- AB-PMJAY Insurance Component: Provides cashless and paperless health coverage of ₹5 lakh per family per year for secondary and tertiary care hospitalisation. It covers pre-existing diseases, has no restriction on family size, age, or gender, and is portable across India.
- PM-ABHIM: The PM Ayushman Bharat Health Infrastructure Mission (PM-ABHIM) focuses on strengthening public health infrastructure, diagnostic networks, and pandemic preparedness with a large financial outlay.
- Ayushman Bharat Digital Mission (ABDM): Creates a digital health ecosystem through unique Health Account IDs enabling secure storage and exchange of medical records.
- Ayushman Arogya Mandirs (AAM): Strengthens primary healthcare by upgrading sub-centres and PHCs into Health and Wellness Centres. It provides free medicines, diagnostics, maternal care, and screening for non-communicable diseases like diabetes, hypertension, and cancer.
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Key Highlights of West Bengal Inclusion:
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- West Bengal becomes the last state to join AB-PMJAY, achieving full national coverage.
- Around 1.43 crore households in the state are expected to benefit.
- Includes coverage for 1.24 crore poor households, 15.95 lakh senior citizens above 70 years, and over 3 lakh frontline workers.
- The Centre has released ₹976 crore as initial funding support.
- Migrant workers will now get nationwide portability of health services.
- West Bengal becomes the last state to join AB-PMJAY, achieving full national coverage.
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Funding and Implementation:
The scheme is a Centrally Sponsored Scheme implemented by the National Health Authority and State Health Agencies. Funding follows a 60:40 ratio for most states, 90:10 for northeastern and Himalayan states, and 100% central funding for Union Territories.
Significance of the Development:
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- Ensures universal health coverage under AB-PMJAY across India.
- Reduces out-of-pocket expenditure and financial distress due to medical emergencies.
- Strengthens portability benefits for migrant workers.
- Enhances cooperative federalism between Centre and states.
- Expands equitable access to secondary and tertiary healthcare.
- Ensures universal health coverage under AB-PMJAY across India.
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Conclusion:
The inclusion of West Bengal marks a major milestone in India’s journey toward universal health coverage. While Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) has significantly reduced financial barriers to healthcare, its long-term success depends on strengthening public health systems, improving implementation efficiency, and ensuring equitable access across regions.
