A 52-year-old man with type 2 diabetes and hypertension presents to a primary health center (PHC) in rural Maharashtra with complaints of chest pain and dyspnea for 2 days. The PHC has basic diagnostic facilities (ECG, blood glucose) but no troponin assay or advanced cardiac imaging. The patient is uninsured and cannot afford private care. According to Ayushman Bharat – Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) guidelines, what is the most appropriate next step in management?

Explanation

## Ayushman Bharat – PMJAY Framework for Referral **Key Point:** AB-PMJAY is a centrally sponsored scheme designed to provide cashless hospitalization to eligible beneficiaries (BPL and APL households) at empaneled health facilities. When a patient presents with a potentially serious condition (acute coronary syndrome in this case) at a PHC without adequate diagnostic or therapeutic capacity, referral to an empaneled secondary or tertiary care hospital is the standard pathway. ## Rationale for Referral 1. **Diagnostic capability gap**: The PHC lacks troponin assay and advanced cardiac imaging, which are essential for confirming acute coronary syndrome. 2. **Therapeutic capacity**: Secondary/tertiary hospitals under AB-PMJAY have interventional cardiology, ICU support, and thrombolytic/antiplatelet therapy protocols. 3. **Financial protection**: The patient is uninsured; AB-PMJAY ensures cashless treatment up to ₹5 lakh per family per year at empaneled hospitals. 4. **Continuity of care**: Referral ensures the patient is managed within the structured AB-PMJAY network, with documented outcomes and quality oversight. ## AB-PMJAY Structure | Component | Role | Responsibility | |-----------|------|----------------| | PHC | First contact, basic screening, referral | Identify need for higher care | | Empaneled secondary hospital | Diagnosis, stabilization, management | Acute care, investigations | | Empaneled tertiary hospital | Complex cases, interventions | Specialized management | | AB-PMJAY portal | Authorization, tracking, payment | Cashless transaction | **High-Yield:** The PHC's role under AB-PMJAY is **triage and referral**, not definitive management of complex acute conditions. Symptomatic treatment at PHC without referral delays diagnosis and risks adverse outcomes in acute coronary syndrome. **Clinical Pearl:** AB-PMJAY empaneled hospitals are contractually bound to provide care without upfront payment; the patient should be issued a referral slip with the hospital's empanelment details to ensure smooth admission.