A 52-year-old woman from a rural village in Madhya Pradesh presents to the Primary Health Centre (PHC) with a 3-month history of progressive dyspnea and chest pain. On examination, she has a systolic murmur and signs of heart failure. Echocardiography reveals severe mitral stenosis requiring valve replacement. The family expresses concern about the cost of surgery. The PHC doctor informs them that the patient is eligible for free treatment under a centrally-sponsored scheme that covers secondary and tertiary care for below-poverty-line families. Which of the following schemes is the doctor referring to?

Explanation

## Identification of the Correct Scheme **Key Point:** AB-PMJAY is the world's largest government-funded health assurance scheme, launched in 2018 as part of the National Health Mission (NHM) to provide universal health coverage. ### AB-PMJAY Coverage and Eligibility | Feature | AB-PMJAY | RSBY | ESIS | CGHS | |---------|----------|------|------|------| | **Target Population** | BPL/APL families (~500M beneficiaries) | Unorganized workers | Organized sector workers | Central government employees | | **Coverage Amount** | ₹5 lakh/family/year | ₹30,000–₹90,000/year | Depends on wage | Cashless at empaneled centers | | **Secondary/Tertiary Care** | Yes, comprehensive | Limited | Limited | Yes | | **Scope** | Nationwide, all states | Limited coverage | Limited | Limited to govt. employees | | **Launch Year** | 2018 | 2007 | 1972 | 1954 | **High-Yield:** AB-PMJAY covers 1,393 procedures across secondary and tertiary care, including cardiac surgery, orthopedic procedures, and oncology. It operates through a network of empaneled public and private hospitals. ### Clinical Pearl: Rural Access Under NHM The vignette specifies a rural PHC patient with a serious cardiac condition requiring tertiary care. AB-PMJAY explicitly aims to bridge the rural-urban healthcare gap by ensuring free access to secondary and tertiary care for economically disadvantaged populations. The scheme covers valve replacement surgery, making it the correct answer in this context. **Key Point:** AB-PMJAY is cashless and paperless at empaneled hospitals — the patient does not pay at point of service; the hospital is reimbursed by the government.