Context: Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY), the flagship health assurance scheme of the Government of India on 21, may,2020 marked 1 crore treatments. 

More on the news: 

  • To mark this milestone, the first edition of Arogya Dhara was inaugurated , a series of webinars created as an open platform for discussion on topical issues of public health.
    • Providing one crore treatments to patients from the country’s poorest households in less than two years ago is a milestone achievement for Ayushman Bharat PMJAY scheme
  • Ask Ayushman chat bot : it was launched on WhatsApp, a 24*7 AI-enabled assistant that provides information on various aspects of the AB-PMJAY scheme such as its benefits,   features, process of making an ecard, locating the nearest
  • Source: Financial Express

empanelled hospital, sharing feedback and the process of lodging a grievance.

  • A Hospital Ranking Dashboard which is a significant step to rank empanelled hospitals on the basis of beneficiaries’ feedback. 
    • The ranking will help the National Health Authority to take evidence based decision making for enhancing the quality measures and indicators of healthcare delivery across all empanelled facilities to further improve the beneficiaries experience.
  • MoHFW and NHA have been consistently developing, sharing, revising all testing, treatment, hospital and related guidelines, insights and information to its beneficiaries, which is of great help in dispelling rumours and myths surrounding COVID-19.
  • States have ensured the scheme delivers on its promise especially in the unprecedented times of COVID-19.
    • The Government of India is making persistent efforts to expand testing and make treatment of COVID-19 available for free to all 53 crore beneficiaries of Ayushman Bharat PMJAY.
      • It further strengthens the Government's resolve, scope and capability to move towards universal health coverage. 

Ayushman Bharat

Ayushman Bharat is a two pronged approach towards Universal Healthcare. 

  • Health and Wellness centres - They will provide comprehensive Primary Health Care, free essential drugs and follow up of hospitalization cases. They will also conduct yoga sessions to promote wellness and have a much wider range of free drugs and diagnostics. 
    • The HWCs serve as the awareness, screening and referral link between patients and PMJAY. 
  • Pradhan Mantri Jan Arogya Yojana (PMJAY) - It provides a health protection cover of rupees 5 lakh per family per year to the bottom 40% of poor and vulnerable population for hospitalization expenses towards the treatment of serious illnesses. 

Ayushman Bharat aims to offer financial risk protection to the beneficiary families through a system of demand led Healthcare initiative that meets their immediate hospitalization needs in a cashless manner. 

Key features of Pradhan Mantri Jan Arogya Yojana 

  • It provides cashless cover upto rupees 5 lakh to each eligible family per annum for listed secondary and tertiary care conditions. 
  • The cover under the scheme includes all the expenses including non-intensive and Intensive Care Services, medicine and Medical consumables and post-hospitalization follow up care upto 15 days. 
  • There is no cap on family size and age of members. 
  • All pre-existing diseases are covered from the very first day unlike private insurance schemes. 
  • Benefits covered under PM-JAY are portable across the country and any eligible beneficiary can visit any empanelled Hospital across the country. 

The stated aims of the insurance portion of the programme include to cushion poor families against the financial shock that a health emergency can trigger, as well as to bring the private sector to small cities. 

Support Mechanisms

  • A National Health Authority (NHA) has been mandated to roll out and coordinate the programme.
  • A cadre of frontline health service professionals called Pradhan Mantri Arogya Mitras (PMAMs) are trained to facilitate provision of treatment to beneficiaries at hospitals. 
  • The scheme is supported by a strong IT backbone that facilitates the identification of beneficiaries, records treatments, processes claims, receives feedback, and addresses grievances. 
  • A live dashboard helps in monitoring and improving performance, based on real-time data and regular analysis. This platform also helps states to compare their performance. 
  • A strong and sophisticated fraud prevention, detection and control system at the national and state level has proved to be critical for PM-JAY to ensure that frauds are largely prevented. If attempted, they are quickly detected and strong action is taken.

Implementation Model 

Considering the fact that states are at different levels of preparedness and have varying capacities the PM-JAY provides them with the flexibility to choose their implementation model which can be through Insurance, Trust or Mix mode. 

  • Insurance Mode - The state government appoints an insurer at a defined rate for taking over the financial risk of the beneficiaries. 
  • Trust Mode - The state government creates an agency which pays the claims of the hospitals as per actual utilisation. The risk of health protection lies with the state. 
  • Mixed Mode - The state uses a combination of insurance and trust modes generally where low-cost common procedure (secondary care) is managed by the insurer and high cost specialised procedures managed by the state trust.

PMJAY, being a centrally sponsored scheme is fully funded from the consolidated fund of India. The expenditure is shared between Central Government and state government as per the sharing instructions issued by the Ministry of Finance. 

PMJAY embodies a policy shift where the government now assumes the role of a purchaser of services from that of the provider and also is surely a giant Leap forward towards the achievement of the sustainable development goals specially SDG 3.8 achieving Universal health coverage.

Source: PIB