Ayushman Bharat

  1. Introduction
  2. Aim
  3. Approach
  4. Key features
  5. Benefits and significance
  6. Eligibility
  7. IMA Suggestions
  8. State’s Response

Introduction

  • Launched as recommended by the National Health Policy 2017, to achieve the vision of Universal Health Coverage (UHC).
  • This initiative has been designed on the lines as to meet SDG and its underlining commitment, which is “leave no one behind”.

Aim

  • to undertake path breaking interventions to holistically address health (covering prevention, promotion and ambulatory care), at primary, secondary and tertiary level.
  • Includes the on-going centrally sponsored schemes – Senior Citizen Health Insurance Scheme (SCHIS) and Rashtriya Swasthya Bima Yojana (RSBY).

Approach

  • Ayushman Bharat adopts a continuum of care approach, comprising of two inter-related components, which are:
    • Health and Wellness Centres (HWCs).
    • Pradhan Mantri Jan Arogya Yojana (PM-JAY).

Key Features of PM-JAY

  • The world’s largest health insurance/ assurance scheme fully financed by the government.
  • It provides cover of 5 lakhs per family per year, for secondary and tertiary care hospitalization across public and private empaneled hospitals in India.
  • Coverage: Over 10.74 crore poor and vulnerable entitled families (approximately 50 crore beneficiaries) are eligible for these benefits.
  • Provides cashless access to health care services for the beneficiary at the point of service.

Benefits and significance

  • Helps reduce catastrophic expenditure for hospitalizations, which pushes 6 crore people into poverty each year.
  • Helps mitigate the financial risk arising out of catastrophic health episodes.

Eligibility

  • No restrictions on family size, age or gender.
  • All pre–existing conditions are covered from day one.
  • Covers up to 3 days of pre-hospitalization and 15 days post-hospitalization expenses such as diagnostics and medicines.
  • Benefits of the scheme are portable across the country.
  • Services include approximately 1,393 procedures covering all the costs related to treatment, including but not limited to drugs, supplies, diagnostic services, physician’s fees, room charges, surgeon charges, OT and ICU charges etc.
  • Public hospitals are reimbursed for the healthcare services at par with the private hospitals.

Suggestions made by Indian Medical Association (IMA):

  • Government hospitals should be removed from the ambit of the scheme as services there are already free of cost.
  • The government should fund public hospitals directly.
  • Under this scheme, it is being done through insurance companies by paying 15 per cent to them.
  • India should not continue the insurance route for healthcare delivery as the administrative cost and the “unholy nexus” with insurance companies point towards profit maximization rather than quality health care delivery.
  • Need of the hour: “Tax funded” universal health coverage rather than the “for profit” insurance model.

Why some states have not implemented the health protection plan and what is holding back its 100 per cent implementation?

  • Few states including Delhi, Telangana, West Bengal and Odisha are not covered.
  • Health is a state subject, and so far these states have declined joining the central government-led scheme.
  • Delhi government argues that it’s existing health scheme has wider coverage and is “10 times bigger than Ayushman Bharat”.
  • Odisha has pointed out certain flaws, saying that the existing Biju Swastya Kalyan Yojana has special provisions like an extra Rs 2 lakh cover for women, which the Ayushman scheme lacks.
  • Telangana too has raised concerns about the rather “narrow ambit” of PM-JAY, saying that its Aarogyasri scheme. benefits more people.
  • West Bengal opted out, refusing to pay its share of the expenditure.