## Ayushman Bharat – PMJAY: Scheme Architecture **Key Point:** AB-PMJAY is a hybrid public–private partnership model. Both government and accredited private hospitals are empanelled and can provide services under the scheme. ### Correct Features of AB-PMJAY | Feature | Detail | |---------|--------| | **Target Population** | BPL, EWS, and marginalized families (approximately 10.74 crore beneficiaries) | | **Coverage Amount** | ₹5 lakh per family per annum (increased from initial ₹3 lakh) | | **Type of Care** | Secondary and tertiary hospitalization (outpatient excluded) | | **Hospital Model** | Both government AND accredited private hospitals empanelled | | **Payment Mechanism** | Cashless and paperless at point of service | | **Portability** | Pan-India coverage; beneficiaries can access care in any state | ### Why Option 3 is Incorrect **High-Yield:** The scheme explicitly encourages private sector participation. Private hospitals meeting accreditation standards (NABH/NABET) can be empanelled to increase bed capacity and reduce burden on government hospitals. This is a key feature distinguishing AB-PMJAY from earlier schemes. ### Key Operational Points 1. **Empanelment:** Both public and private hospitals can be empanelled after meeting quality standards 2. **Beneficiary Choice:** Beneficiaries can choose from empanelled hospitals (government or private) 3. **Cashless Service:** No out-of-pocket payment at the point of service 4. **Portability:** Beneficiaries can access services across state boundaries **Clinical Pearl:** The inclusion of private hospitals was a deliberate policy decision to increase healthcare access, reduce waiting times, and utilize existing private sector capacity without additional government expenditure on infrastructure. [cite:Park 26e Ch 3]
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