Which of the following is a health assurance scheme which aims at providing a health cover of ₹5 lakh per family per year for secondary and tertiary care hospitalisation to over 12 crore poor and vulnerable families that form the bottom 40% of the Indian population?

Appeared in: DSSSB October 2024

Explanation

Pradhan Mantri Jan Arogya Yojana (PMJAY), part of the Ayushman Bharat mission, is a national health insurance scheme of the Government of India.
It provides a substantial health cover of ₹5 lakh per family per year for secondary and tertiary care hospitalization, aiming to protect families from catastrophic health expenditure.
The scheme targets over 10.74 crore (now expanded) poor and vulnerable families, which constitute approximately the bottom 40% of India's population, based on the Socio-Economic Caste Census (SECC) database.

Option A: Pradhan Mantri Ujjwala Yojana (PMUY) is not a health insurance scheme. Its objective is to provide clean cooking fuel (LPG) to women from impoverished households to prevent respiratory illnesses caused by indoor air pollution.
Option B: Pradhan Mantri MUDRA Yojana is a financial scheme, not a health scheme. It facilitates access to credit for non-corporate, non-farm small/micro-enterprises.
Option C: Pradhan Mantri Matru Vandana Yojana (PMMVY) is a maternity benefit program. It provides a cash incentive to pregnant and lactating mothers for their first child, focusing on nutrition and partial wage compensation, not hospitalization insurance.

Clinical Relevance

Nursing practice connection: Knowing Government Health Schemes in India helps nurses interpret findings accurately and avoid errors in routine assessment, medication administration, and patient teaching.
Nurses are at the forefront of implementing PMJAY in empanelled hospitals. They are responsible for identifying eligible patients, assisting with documentation, ensuring cashless service delivery, and coordinating with 'Ayushman Mitras' (patient facilitators).
Knowledge of PMJAY allows nurses to act as patient advocates, ensuring that eligible individuals receive necessary secondary or tertiary care without facing financial barriers, thereby improving health outcomes and reducing out-of-pocket expenditure.
What if? If a patient under PMJAY requires a treatment or procedure not listed in the 1600+ predefined packages, the hospital's PMJAY coordinator may need to seek pre-authorization or clarification, and the cost may not be covered, highlighting the importance of understanding the scheme's scope.

How to Approach the Question

First, dissect the question to identify the core components of the scheme described. Key phrases are 'health assurance', '₹5 lakh cover', 'secondary and tertiary care', and 'poor and vulnerable families'.
Next, systematically review each option, recalling the main purpose of that specific government program.
Eliminate options that do not match the core components. PMUY is about cooking fuel, PM MUDRA is about business loans, and PMMVY is about maternity benefits. None of these are comprehensive hospitalization insurance schemes.
Confirm that the remaining option, PMJAY, aligns with all the key descriptors from the question. The ₹5 lakh cover for hospitalization for poor families is the defining feature of PMJAY.
This type of question tests factual recall of major national policies. Creating flashcards or a summary table of important schemes can be an effective study strategy.

Concept Tested & Keywords

Concept Tested: Government Health Schemes in India
Stem keywords: health assurance scheme, ₹5 lakh per family per year, secondary and tertiary care hospitalisation, poor and vulnerable families, bottom 40% of the Indian population
Lead-in keywords: Which of the following
Negative lead-in flag: false

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E6 Parks TextBook of Preventive & Social Medicine part 2 — Subpart A (pp 1-232 of 464) p. 139-141

E6 Comprehensive Textbook of Community Health NursingShyamala D part 1 (pp 26-389 of 389) p. 95-97

E6 Parks TextBook of Preventive & Social Medicine part 1 — Subpart C (pp 404-604 of 604) p. 165-167

Practise the full DSSSB October 2024

Attempt every question from this paper in a timed mock, then review the full solution for each one.