Also, know how Ayushman Bharat Yojana has changed many lives

In the continuation of exploring the various health programs and schemes, we will have a brief look into the Ayushman Bharat Yojana, a flagship scheme of the Modi government to provide health insurance to the poor people of the country.

Under the National Health Mission, the government of India launched a flagship scheme, Ayushman Bharat to achieve the vision of Universal Health Coverage (UHC). The Aysuhman Bharat Yojana is designed to meet the sustainable development goals and the underlining commitment of it, which says- “leave no one behind.”

This initiative is an attempt to move towards a comprehensive need-based health care service from the sectoral and segmented approach of health service delivery. The aim of this scheme is to undertake path-breaking interventions to address the healthcare system holistically at the tertiary, secondary and primary level by covering prevention, promotion and ambulatory care. The programme has two inter- related components – Health and Wellness Centres (HWCs), and Pradhan Mantri Jan Arogya Yojana (PM-JAY).

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What are Health and Wellness Centres

The Modi government announced the creation of about 1.5 lakh Health and Wellness Centres by transforming the existing Primary Health Centres and Sub Centres in 2018. These centres were designed to deliver Comprehensive Primary Health Care by bringing health care closer to homes of people. These centres cover child health services, maternal health service and non-communicable diseases. Diagnostic services and essential drugs are provided at free of cost.

They are designed to deliver an expanded range of services to address the basic health care service to everyone. The emphasis on health prevention and promotion is to bring focus on keeping people healthy by empowering and engaging individuals and communities to choose healthy behaviours and make changes that reduce the risk of developing morbidities and chronic diseases.

What is Pradhan Mantri Jan Arogya Yojana

Pradhan Mantri Jan Arogya Yojana or PM-JAY was launched on 23rd September 2018 in Ranchi, Jharkhand, by the Indian Prime Minister, Narendra Modi. It is the largest health assurance scheme in the world which aims at providing a health coverage of Rs 5 lakhs per family for tertiary and secondary hospitalization to over 10.74 crores vulnerable and poor families, amounting to a total of 50 crore beneficiaries from the bottom 40 percent of the Indian population.

People are insured under the Ayushman Bharat Yojana based on the occupational and deprivation criteria of Socio-Economic Caste Census 2011 (SECC 2011) for urban and rural areas respectively. PM-JAY was known as National Health Protection Scheme (NHPS). It subsumed Rashtriya Swasthya Bima Yojana (RSBY), which was launched in 2008. So, the family covered under the Pradhan Mantri Jan Arogya Yojana also includes families who were covered in RSBY but were not present in the SECC 2011 database. The program is fully funded by the Government and cost of implementation is shared between the State and Central government.

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Main features of PM-JAY

1. PM-JAY is the largest health insurance/assurance scheme in the world which is financed by the government.

2. It provides cashless access to health care services for people at hospitals.

3. The scheme has the vision to help mitigate catastrophic expenditure on medical treatment which pushes about 6 crore people in India to poverty each year.

4. The PM-JAY covers up to 15 days post-hospitalization and 3 days of pre-hospitalization expenses such as medicines and diagnostics.

5. Like private insurance, PM-JAY covers all pre-existing conditions and there is no restriction on age, gender and family size.

6. Beneficiaries can visit any empanelled private and government hospital in India to avail cashless treatment as benefits of the scheme are available across the country.

7. About 1,393 procedures are covered with all the costs related to treatment including medicines, diagnostic services, supplies, room charges, OT, surgeon services, physician fees, ICU charges and more.

Benefit Cover Under PM-JAY

In India, the government-funded insurance covers have always been structured on an upper ceiling limit up to an annual cover of 30 thousand rupees to 3 lakhs per family across various states which created a fragmented system. But the PM-JAY provides cashless cover up to Rs 5 lakhs.

The cover of Rs 5 lakh is on a family floater basis which means, that it can be used by anyone from the family members or all of them. The RSBY has a family cap of 5 members but learning from these schemes, PM-JAY is designed in such a way that there is no cap on the number of individuals. Also, pre-existing diseases are covered from the first day. This means that people who already have a medical condition before being covered by PM-JAY will now be able to get treatment for all those medical conditions from the day of enrollment.

Here is how Ayushman Bharat Yojana is changing the lives of people.

As per reports, a 40-year-old individual was suffering from severe spinal cord lesions in Jharkhand. He/she wasn’t able to treat it because of lack of funds. But, with the help of PM-JAY, his/her illness was cured in one of the wellness centres in the Bokaro district of the state.

An old farmer had undergone expensive surgeries like binary drainage procedure with stent placement in the Yavatmal district of Maharashtra.

A 20-year-old young teen suffered from severe burns in the Karimganj district of Assam. The burn was so severe that it was impossible to ignore the treatment. With the help of quality services and cashless hospitalization, the boy was treated, which took him out of severe condition.

What will change after Ayushman Bharat Yojana?

A whitepaper by SKP titled “National Health Protection Scheme: Ayushman Bharat- Growing Opportunities in Affordable Healthcare”, examined the impact of Pradhan Mantri Jan Kalyan Yojana. It said that the medical equipment segment will emerge as the biggest beneficiary of the programme with additional revenues of around Rs 14,351 crore. The whitepaper said that medical devices in India are at a very nascent stage, as they are very small in comparison to other developing and emerging countries.

The paper said that per capita expenditure on medical devices in India is very low at USD 3, compared to USD 340 in the USA and USD 13 in China. For a population of 1.35 crore, India has a size of just USD 7 billion in the industry.

The Whitepaper had suggested that it would increase in the next three years with an additional service revenue of USD 2.0 billion. Disposables and medical consumables will constitute 20 percent of this revenue.

Impact of Ayushman Bharat Yojana

It has been just 2 years since the launch of this flagship programme. There has been hardly any research on the impact of the programme. However, the official website for PM-JAY says that about 12.55 crore e-cards have been issued until August 2020. There has been 1.09 crore hospital admission and about 22,796 hospitals have been empanelled.

The biggest challenge for Ayushman Bharat Yojana is to make people aware about both the components of the programme – PM-JAY and Health and Wellness Centre. In rural areas, the people we talked to, were not aware of the scheme and said that they don’t know anything about such a scheme. Some knew about the scheme but didn’t know how to avail its benefits.

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