A 38-year-old man with diabetes and hypertension visits a government health sub-centre in a tribal area of Odisha for routine check-up. The health worker identifies him as having uncontrolled hypertension (BP 160/100 mmHg) and refers him to a district hospital for further management. At the district hospital, he undergoes investigations and is diagnosed with chronic kidney disease stage 3b. He is enrolled in a scheme that provides him with a health ID card and ensures he receives free treatment at the hospital without paying at the point of service. Which of the following best describes the primary objective of the scheme under which this patient is enrolled?

Explanation

## Understanding AB-PMJAY's Core Objective **Key Point:** The primary objective of AB-PMJAY (Ayushman Bharat – Pradhan Mantri Jan Arogya Yojana) is to achieve universal health coverage (UHC) by reducing catastrophic out-of-pocket (OOP) expenditure on health and ensuring equitable access to secondary and tertiary care. ### AB-PMJAY Operational Framework ```mermaid flowchart TD A[Beneficiary Identification<br/>via SECC data]:::action --> B[Health ID Card Issuance]:::action B --> C{Type of Care Needed}:::decision C -->|Primary| D[Sub-centre/PHC<br/>Free services]:::outcome C -->|Secondary/Tertiary| E[Empaneled Hospital<br/>Cashless treatment]:::action E --> F[Hospital claims<br/>from government]:::action F --> G[Reduced OOP expenditure<br/>UHC achieved]:::outcome ``` ### Vignette Alignment with AB-PMJAY | Feature in Case | AB-PMJAY Provision | |-----------------|-------------------| | Health ID card issued | Yes — unique identification for cashless access | | Free treatment at district hospital | Yes — secondary/tertiary care covered | | No payment at point of service | Yes — cashless scheme | | Chronic kidney disease management | Yes — covered under 1,393 procedures | | Applicable in tribal/rural area | Yes — nationwide coverage | **High-Yield:** AB-PMJAY covers ₹5 lakh per family per annum for secondary and tertiary care. Out-of-pocket expenditure reduction is the core metric of success — the scheme aims to prevent financial catastrophe from health shocks. ### Clinical Pearl: Why This Scheme Matters Before AB-PMJAY, a patient with CKD stage 3b requiring dialysis or transplant evaluation would face catastrophic costs (₹3–5 lakh annually for dialysis alone). The scheme ensures such patients receive care without financial ruin, directly addressing India's high OOP health expenditure (>50% of total health spending pre-2018). **Key Point:** The health ID card is the operational gateway — it enables real-time eligibility verification and seamless cashless transactions across the empaneled network.