PMJAY (Pradhan Mantri Jan Aarogya Yojana), Foreign Fats in TTD Laddu, White Revolutions 2.0

(General Studies II – Health – Issues relating to the development and management of Social Sector/Services relating to Health, Education, and Human Resources)

• Ayushman Bharat is the government’s flagship programme to achieve universal health coverage (UHC).
• The scheme has two inter-related components: health and wellness centres and the Pradhan Mantri Jan Arogya Yojana (PMJAY) that aims to provide a health cover of ₹5 lakh per family per year for secondary and tertiary care hospitalisation to over 12 crore families that form the bottom 40% of the population.

Implementation Challenges –

• Dues and Delays:  Hospitals report substantial unpaid dues and delays in receiving payments from some states despite the guidelines being clear about turnaround time.
• Hospital Turnaways: Some hospitals are turning away or limiting the intake of PMJAY patients due to the risk of claim rejection, which means the insurance company may reject a claim because of documentation errors or a technicality even after surgery or treatment.
• Cap on Charges: The union government has put a cap on the amount Hospitals can charge for different treatments. That doesn’t always work well for private providers.
• Inefficiency in Resource Allocation: The union government is meant to allocate 60% of PMJAY funds, but the amount it is spending is less than this. High out-of-pocket expenditures indicate inefficiencies and misallocation, particularly in the public sector.
• Coverage Limitation: PMJAY covers less than 2.5% of total health expenditure, not sufficient for comprehensive health coverage.
• Capacity Issues: In many states, the number of people per empanelled healthcare provider (EHCP) is high. In Bihar, it was over 10,000 families per EHCP.
• Service Disparity: Private hospitals are perceived to provide better care, leading to preferential use over available public hospitals.
• Inactive Facilities: Not only do hospitals not exist in many parts, but even empanelled hospitals haven’t been active. For example, in Uttar Pradesh, 39% of empanelled hospitals have been inactive since their enrollment.
• Claim Processing: Governance processes make a big difference. Delays exceeding 45 days in some states contrast with faster processing in others.
• Coverage Gaps: The focus on inpatient care excludes significant areas like outpatient care, diagnostics, and drugs.

Recommendations for Improvement –

• Public Sector Performance: There is a need of a stronger role for public insurance to enhance healthcare quality and efficiency.
• Public Service: The private sector is unlikely to go to remote places and build a hospital. It would have to be led by the public sector for the foreseeable future.
• Integration of Healthcare expenditure: The largest component of healthcare expenditures are government expenditures through the State and Centre and they are multiples higher than what these two schemes are doing. Therefore, there is a need to have an integration of public sector health expenditure and PMJAY.
• Network Adequacy: There is a need to have an obligation for the insurer to have network adequacy meaning you can’t offer an insurance scheme unless you have hospitals nearby.
• Enhanced Coverage: Expansion of PMJAY to include outpatient care, diagnostics, and drugs to provide comprehensive health coverage as the bulk of the expenditure is on drugs and OP care.
• Efficiency Improvements: Need to address inefficiencies and resource misallocation to reduce dependency on the overstretched private sector.

Way Forward –

• Countries like Thailand, Turkey, Vietnam, and Uruguay have successfully implemented Universal Health Care using an insurance model. This approach addresses the issue of misallocation of government resources often exacerbated by schemes focused solely on hospital-centric designs.
• A recent study on health insurance in low- and middle-income countries highlighted that the challenge extends beyond the method of channelling government subsidies—whether through health insurance or direct public facility subsidies. The focus should be on establishing specific payment structures and non-price mechanisms that effectively alter both provider behaviour and patient choices.

• The discovery of the Harappan civilisation published in 1924 revealed the existence of an advanced, Bronze Age civilisation in the Indus Valley.
• This discovery marked a pivotal moment in South Asian history, uncovering a previously unknown civilisation with technological and cultural achievements comparable to ancient Egypt and Mesopotamia.
• The civilisation was initially called the “Indus Valley Civilization.”
• Evolution and Expanse of Civilisation:
• The civilization is divided into three phases: early (3200-2600 BC), mature (2600-1900 BC), and late (1900-1500 BC).
• It spanned 1.5 million square kilometres, covering parts of India, Pakistan, and Afghanistan.
• Major sites include Harappa, Mohenjo-daro, Rakhigarhi, Dholavira, and Ganweriwala.
• Features:
• The Harappan civilization excelled in urban planning, water management, and the construction of fortified cities.
• They built sophisticated drainage systems, warehouses, and seafaring boats.
• Their craftsmanship included bronze and copper artefacts, beads, painted pottery, and intricate seals with animal motifs and inscriptions.
• The civilization featured a standard script, sophisticated lapidary techniques, and standard brick sizes.
• They practised a combination of binary and decimal systems for weights and measures.
• The Harappans had maritime trade connections with West Asia as early as 3000 BC.

Dig Deeper: Read about various recent discoveries of skeletons and their genetic study at Rakhigarhi.

• Union Home and Cooperation Minister launched ‘White Revolution 2.0’ to enhance milk procurement through cooperatives, empowering women and fighting malnutrition.
• The initiative focuses on strengthening cooperatives nationwide.
• Production: The initiative aims to increase daily milk procurement from 660 lakh litres to 1,000 lakh litres.
• DBT: Payments will be directly deposited into the bank accounts of the women involved.
• Formalisation of Employment: The scheme focuses on recognizing women’s contributions to milk procurement, formally including them in the employment sector.
• Cooperatives-led Revolution: A joint proposal for the registration of two lakh Primary Agriculture Cooperative Societies (PACS), dairy, and fishery cooperatives has been accepted nationwide.
• The goal is to ensure every panchayat has a PACS, dairy, or fishery cooperative.
• This expansion will enhance cooperative institutions at the tehsil, district, and state levels, ensuring stronger and more widespread cooperative systems.

Dig Deeper:  Read about nutrition factors in the context of the A1, A2 debate.

• A controversy emerged regarding the quality of ghee used by the Tirumala Tirupati Devasthanams (TTD) for offerings (naivedyam) and laddu prasadam at the Sri Venkateswara temple, as reports suggested the presence of foreign fats in the ghee.
• Ghee Quality Analysis: The National Dairy Development Board’s (NDDB) Centre for Analysis and Learning in Livestock and Food (CALF) found that the ghee used by TTD contained foreign fats like fish oil, beef tallow, and lard, along with various vegetable oils.
• The findings were based on the “S-values” analysis for Milk Fat Purity, where all five values fell outside the ISO-prescribed limits, indicating the presence of foreign fats.
• Potential Contamination Factors: The NDDB report also mentioned possible factors that could lead to false positives in such tests, including underfeeding or overfeeding cows with feeds rich in vegetable oils and milk obtained from colostrum.
• Test Methodology: The compliance with ISO standards (ISO 17678:2019) for milk fat integrity is examined using gas chromatographic analysis of triglycerides, which was conducted by CALF and reported to the TTD’s Water and Food Analysis Lab in July 2024.

Dig Deeper: Read about ISO 17678: 2019 standards- Milk and milk products Determination of milk fat purity by gas chromatographic analysis of triglycerides.