WHAT IS AYUSHMAN BHARAT SCHEME 2018?











Published by: Aakansha Singh


Introduction

Ayushman Bharat Yojna is one of the most ambitious projects of the Modi Government to provide universal health care to around 40% of the Indian population covering up to Rs. 5 lakh per family yearly assistance. The Yojna was first announced in February 2018 in the Union budget of India and then, launched on 23 September 2018 in Ranchi, Jharkhand as Pradhan Mantri Jan Arogya Yojna (AB-PMJAY) to achieve the vision of Universal Health Coverage. This initiative has been designed to meet Sustainable Development Goals (SDGs) and its underlining commitment, which is to "leave no one behind".


The Ayushman Bharat Yojana - National Health Protection Scheme, is formed by subsuming multiple previous schemes including Rashtriya Swasthya Bima Yojana, Senior citizen health Insurance Scheme, Central Government Health Scheme etc. This scheme aims to address the healthcare system (covering prevention, promotion and ambulatory care) at the primary, secondary and tertiary level.


Need for Ayushman Bharat Yojna

The need for the scheme felt when the 71st round of the National Sample Survey Office (NSSO) revealed some shocking facts about the country’s healthcare system. According to NSSO, about 86% of rural families and 82% of urban families are not having health insurance and about 17% of the country’s population spend the only 1/10th of their household budgets to avail health services. And around 19% of the urban population and 24% of the rural population meet their healthcare expenses by borrowings which often lead them into the debt trap. Therefore, to address these concerns, the government launched the Ayushman Bharat programme under the National Health Policy 2017.



Key Features of Ayushman Bharat-Pradhan Mantri Jan Arogya Yojna:

  • It is one of the world’s largest health insurance schemes providing coverage of Rs.5 lakh per family per year for secondary and tertiary care.

  • Over 50 crore beneficiaries are entitled under the scheme.

  • Eligibility Criteria is determined by the Socio-Economic and Caste Census 2011.

  • The scheme is portable and a beneficiary can get medical treatment at any PM-JAY empanelled hospital anywhere in India.

  • It has a system of Cashless payment and paperless recordkeeping through an e-card.

  • It gives coverage to 3 days pre-hospitalization expenses and 15 days post-hospitalization expenses such as medicines and diagnostics.

  • There is no cap on the family size, gender or age.

  • Services are given from day one.

  • The scheme includes 1393 medical procedures.

  • It includes costs for diagnostic services, drugs, room charges, physician’s fees, surgeon charges, supplies, ICU and OT charges.

  • Public hospitals are reimbursed at par with private hospitals.

Eligibility Criteria under the Scheme

The Government is using the Socio-Economic Caste Census 2011 (SECC 2011) to determine the eligibility of beneficiaries under the Scheme which provides a ranking of households based on their socio-economic status. The rural households are ranked based on their status of different deprivation criteria whereas the urban households are based on occupation.


AB-PMJAY Rural

· Households with only one room with Kachaa walls or roof.

· No adult member or male member in the family of the age group between 16 and 59 years.

· Disabled member and no-abled bodied member in the household.

· SC and ST Households.

· Landless households or those who are dependent on manual casual labour.


AB-PMJAY Urban

· Beggar

· Domestic worker

· Ragpicker

· Cobbler/Street Vendor/Hawker/Other service providers on the street.

· Plumber/Construction Worker/Mason/Painter/Labour/Welder/Security Guard/Coolie.

· Sweeper/Mali/Sanitation Worker.

· Artisan/Handicrafts Worker/Tailor/Home-based Worker.

· Driver/Transport Worker/Conductor/Cart or Rickshaw Pullers/Helper to Drivers or Conductors.

· Shop Workers/Peon in Small Establishment/Assistant/Helper/Attendant/Delivery Assistant/Waiter.

· Mechanic/Electrician/Repair Worker/Assembler.

· Chowkidar/Washer-man.


Who is not entitled to avail the Ayushman Bharat Scheme?

· Those who have mechanised farming equipment.

· Who owns a two, three or four-wheeler vehicles.

· Those who hold a Kisan card.

· Government employees.

· Those who own a motorised fishing boat.

· Those who are earning more than Rs.10,000 per month.

· Those who are working in government-run non-agricultural enterprises.

· Those who own more than 5 acres of agricultural land.

· Those who own landline phones or refrigerators.

· Those who live in a decent house.



Which Illness are Covered under the Scheme?

The medical care scheme extended coverage for more than 1300 medical packages at empanelled public and private hospitals in the country. Below are some of the critical illnesses covered under the AB-PMJAY:

· Prostate cancer.

· Double valve replacement.

· Coronary artery bypass graft.

· COVID-19.

· Pulmonary valve replacement.

· Skull base surgery.

· Anterior spine fixation.

· Laryngopharyngectomy with gastric pull-up.

· Tissue expander for disfigurement following burns.

· Carotid angioplasty with stent.


What is not covered under the Scheme?

· OPD.

· Drug rehabilitation programme.

· Cosmetic related procedures.

· Fertility related procedures.

· Organ transplants.

· Diagnostics.


Which hospitals can be empanelled under the Scheme?

Under the Scheme, both government and private hospitals can be empanelled. Till now, over 15,000 hospitals part of it and 50% of the empanelled hospitals are estimated to be private hospitals.

National Health Authority (NHA), is the implementing body of AB-PMJAY. It has formulated guidelines for the empanelment process for Pradhan Mantri Jan Arogya Yojana.


Ayushman Bharat e-card

Under the Ayushman Bharat Yojna, Golden cards are issued to beneficiaries in order to ensure cashless, paperless and portable transactions. The PMJAY e-card contains all information related to the patient. Patients must present the card at the time of availing the treatment at the empanelled hospital, without it they cannot get benefits under the scheme.


How to get the Card?

For getting the card, one needs to be eligible for Ayushman Bharat Yojana which is determined by the SECC 2011 or those who are already a part of the RSBY plan.

Once you are eligible for the PMJAY benefits, you can proceed for getting an e-card. For that purpose, you need to verify your identity at a PMJAY kiosk with the help of a document like your Aadhaar card or ration card. Family identification proofs that can also be produced such as the government-certified list of members, or RSBY card. Once the verification is completed, the e-card is printed along with the unique AB-PMJAY ID.


How to lodge a complaint or grievance on the PMJAY portal

A complaint can be lodged either online or offline. Online complaints can be registered at www.cgrms.pmjay.gov.in and offline can be lodged by Contacting the PMJAY helpline centre operated by your State/NHA by Sending a letter, email, or fax or directly meeting with the District Grievance Nodal Officer (DGNO) of your district where the complaints are formally processed.


Benefits of Ayushman Bharat Yojana Scheme:

· It covers all hospitalization expenses with cashless transactions and reduces the medical expenditure of many poor families and provides quality medical services.

· It reduces the burden of the family as they don’t need to borrow money which saves them from the debt trap.

· The scheme prescribes hospitals to maintain a certain minimum standard thereby ensuring quality services.

· The scheme has the potential to reforms India’s healthcare system.

· It is said that within one year of the scheme, beneficiary families saved over Rs.13000 crores.

· Private hospitals are playing a vital role as they are treating up to 60% cases. Therefore, it is very clear that they have also benefitted from it as the number of patients has been increased in private hospitals.

· Now even economically weaker sections of society can have access to quality healthcare services without any financial hardships.

· The scheme is contributing to the employment rate as it is creating many jobs in the health sector. In the year 2018 only, it has generated more than 50,000 jobs. This number is expected to increase as the government is planning to build 1.5 lakh HWCs by 2022.

· Further, the scheme has a robust IT framework. IT supports extend to beneficiary identification, maintaining treatment records, processes claims, addresses grievances, etc

· There is less chance of corruption and fraud as fraud detection, prevention, and control system is established at both the central and state levels.



Criticisms of the Scheme

There are certain criticisms and challenges in the implementation of the scheme. They are briefly discussed below.

· There has been a criticism that the scheme is eating the funds of the National Rural Health Mission as all funds are given to the Scheme.

· Further, there have been protests by many people in various states as the private sector has been given a large role in offering primary health care and the sector is not much regulated by the government.

  • There is a shortfall of healthcare professionals to implement a vast scheme like this.

  • It has been also alleged that many primary healthcare centres don’t have proper infrastructure and running without even the basic facilities such as electricity, regular water supply, etc.

  • The scheme excludes the poor people of organized sector irrespective that they don’t have access to health insurance.

Conclusion

The Ayushman Bharat Yojna is a visionary scheme that aims at the fulfilment of the concept of Universal Health Coverage by providing health insurance to underprivileged families so that they can effectively tackle medical emergencies. In the last two years, the scheme has achieved many milestones. The scheme achieved 1 crore treatments to poor households and these treatments worth Rs 13,412 crore have been provided through a growing network of 21,565 public and private empanelled hospitals. The government also trying to expand testing and make treatment of COVID-19 available for free to all 53 crore beneficiaries under Ayushman Bharat PMJAY. Therefore, undoubtedly the Scheme is a god-gift to the poor households.




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