## Distinguishing Feature: Cashless Coverage Model ### PM-JAY vs RSBY: Key Structural Differences **Key Point:** PM-JAY introduced a true cashless, no-cost-at-point-of-care model for secondary and tertiary care, whereas RSBY required beneficiary co-payments and had a lower benefit ceiling. | Feature | PM-JAY (Ayushman Bharat) | RSBY | |---------|--------------------------|------| | **Beneficiary Population** | 10.74 crore poor & vulnerable families (~50 crore individuals) | ~3 crore unorganized sector workers & families | | **Annual Benefit** | ₹5 lakh per family per year | ₹30,000 per family per year | | **Cost at Point of Care** | **Zero — fully cashless** | Co-payment required (10–15%) | | **Scope** | Secondary & tertiary inpatient care | Inpatient + limited outpatient | | **Hospital Empanelment** | Public + private (tier 2 & 3 cities prioritized) | Public + private | | **Portability** | Pan-India (across states) | State-specific | ### Clinical Pearl **High-Yield:** PM-JAY's **zero out-of-pocket cost at the point of service** is the single most transformative feature — it removes the financial barrier that RSBY beneficiaries faced, directly addressing catastrophic health expenditure in India's poorest households. ### Why This Matters for NEET PG PSM Understanding the policy evolution from RSBY → PM-JAY reflects India's shift from co-payment-based to fully subsidized health protection, aligning with UHC principles and reducing financial hardship from hospitalization. [cite:Park 26e Ch 3, NHM Framework Documents]
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