32-crore-used-ayushman-scheme

Context-

In a recent statement, the Union health ministry informed that till date more than 18 crore health cards have been issued all over India under the Ayushman Bharat ­ Pradhan Mantri Jan Arogya Yojana (AB­PMJAY) scheme and over 3.2 crore people have availed the hospital facilities under the scheme.

Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB PMJAY)

  • It was launched in September 2018 by the Government of India
  • It aims to offer secondary and tertiary care services to the vulnerable sections of our population
  • It is a component of the ‘Ayushman Bharat’ scheme besides “Health and
    Wellness centres”
  • Under this scheme poor and vulnerable families are provided medical coverage of Rs. 5 lakh per family per year for secondary and tertiary care hospitalisation.
  • The scheme covers nearly 40% of the total Indian population
  • It is the world’s largest health insurance scheme fully financed by the government
  • National Health Authority(NHA) is the nodal agency for its nationwide rollout and preparation
  • It provides cashless healthcare service to the beneficiary
  • It is a centrally sponsored scheme
  • It offers Health Benefit Packages which covers surgery, medical and day care treatments, cost of medicines and diagnostics.
  • All pre–existing conditions are covered from day one.
  • Covers 3 days of pre-hospitalization and 15 days post-hospitalization expenses which covers diagnostics and medicines.
  • Benefits of the scheme are portable across the country.
  • Public hospitals are reimbursed at par with the private healthcare establishments.

Eligibility

  • The scheme is targeted to cover 10.74 crore poor, deprived families and identified the occupational category of urban worker’s families.
  • No restrictions on family size, age or gender.
  • The beneficiaries are identified based on the latest Socio-Economic Caste Census (SECC) data through an entitlement based scheme.

Role of National Health Authority (NHA)

  • NHA is the apex body entrusted with the responsibility for implementing India’s flagship public health insurance scheme - Ayushman Bharat Pradhan Mantri Jan Arogya Yojana.
  • It has the following roles
  • Strategy ilding
  • Developing the technological infrastructure
  • Implementating the National Digital Health Mission to create a National Digital Health Eco-system
  • To implement the scheme at the State level, State Health Agencies (SHAs) are also setup by the respective states.

Funding:

  • The financing of the scheme is done jointly by entre and states in the following ratio-
  • 60:40 for all states and UTs with their own legislature, 
  • 90:10 in Northeast states and Jammu and Kashmir, Himachal and Uttarakhand and 
  • 100% Central funding for UTs without legislature.

Challenges:

  • There is often a lack of cooperation from states mostly due to political reasons and because of clash with their pre existing state health schemes. States like West Bengal, Odisha, Telangana have not implemented PMJAY. It is also important to note that health is a state subject, for which many things fall under their discretion of implementation/
  • There is a disparity regarding common consensus on health costs between the centre and private caregivers. Many hospitals find the government’s proposals as unviable.
  • Public facilities are already overburdened and lack critical infrastructure so they need necessary partnerships and coalitions with private-sector health care providers.
  • In such circumstances, the provision of services can be ensured only if the providers are held accountable for their services.
  • Lack of standardized guidelines and treatment protocols, regarding financial compensation package, to check on the potential for unnecessary treatment.

Achievements:

  • It has really helped the poor strata of our society, In around the first 200 days of implementation, the scheme benefitted more than 20.8 lakh poor and deprived people who received free treatment worth more than Rs. 5,000 crores.
  • It was a real boon during covid, because the portability feature of the scheme, helps to ensure that any PM-JAY-eligible migrant worker could access the scheme from any part of the country, irrespective of their state of residence.