Rajya Sabha TV In Depth: Ayushman Bharat – Insuring Health
(TOPICS COVERED: PAPER III, GENERAL STUDIES II – Government policies, Issues related to development and management of Social Sector Services relating to Health)
Prime Minister Narendra Modi launched the Pradhan Mantri Jan Aarogya Yojna (PMJAY-Ayushman Bharat) scheme in Ranchi on 23rd September 2018. Deemed the world’s largest Government-funded heath care programme, it covers over 50 crore beneficiaries. It is expected to have a far-reaching impact on country’s healthcare and insurance landscape.
FEATURES OF THE SCHEME:
- The scheme has two objectives:
- Creating a network of health and wellness infrastructure across the nation (for primary health care services).
- Provide insurance cover to minimum 40% of India’s total population (for secondary and tertiary health care services).
- Beneficiaries of heath insurance under the scheme will include 50 crore economically weak citizens of India as defined in the social, economic and ethnic census 2011 database. It will cover both rural (8.03 crore) and urban (2.33 crore) families.
- Ayushman Bharat will subsume the existing Rashtriya Sawasthya Bima Yojna, launched in 2008 and the Senior Citizens Health Insurance Scheme.
- It will provide a benefit cover of Rs 5 lakh/year/family.
- Expenses incurred will be shared between Centre and States in 60:40 ratio.
- The Government aims to open 5 lakh health and wellness centre by 2022 that will be equipped to treat various diseases.
- Ayushman Bharat will take care of secondary care and tertiary care procedures and also cover pre and post-hospitalisation expenses.
- Cashless benefits will be allowed from any public or private empanelled hospitals. Such empanelled hospitals will have ‘Ayushman Mitra’ to assist patients.
- Benefits can be availed from any place in India and no hospital can refuse treatment under this scheme.
- Guidelines have been given by the Government about families that can’t avail the benefits under the scheme. For example- Families with credit card limit of over Rs 50,000, families where a member has a government job, etc.
- If implemented properly, the scheme will bring the nation closer to the Sustainable Development Goal of Universal Health Coverage.
SPENDING ON HEALTHCARE IN INDIA:
- Between 2008 and 2015, public health expenditure (Centre and State Governments combined) remained constant at 3% of GDP.
- It increased marginally to 1.4% in 2016-2017. But it is still low compared to world average of 6%.
- The deficient investment in public spending on health has resulted in poor infrastructure and inadequate human resources.
- About 70% healthcare services are provided by private sector.
- Consumers are forced to bear cost of their own healthcare.
The healthcare services available in India need to developed and their affordability for its citizens has to be improved. As the public spending on these services are quite low compared to the world average, schemes like Ayushman Bharat are a welcome step. The Government and private hospitals need to cooperate so that a scenario of universal heath coverage in India may get closer and poor people are able to get better and affordable heath care services.