Ayushman Bharat Yojana

Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (PM-JAY, translation: Longeval India Prime Minister's People's Health) of the Government of India to provide free access to healthcare for 40% of people in the country.[2] People using the program access their own primary care services from a family doctor. When anyone needs additional care, then AB PM-JAY provides free secondary health care for those needing specialist treatment and tertiary health care for those requiring hospitalization.[3] The program is a centrally sponsored and is jointly funded by both the federal government and the states.

Urban Primary Health Centre Ayushman Bharat Bidipeth Nagpur

Ayushman Bharat Yojana
Type of projectHealth insurance
CountryIndia
MinistryMinistry of Health and Family Welfare
Launched23 September 2018 (2018-09-23)
Budget$ 1.43 billion[1]
StatusY Active
Websitehttps://www.pmjay.gov.in/

The programme is a Union Government and part of the Indian government's National Health Policy. It was launched in September 2018 by the Ministry of Health and Family Welfare. That ministry later established the National Health Authority as an organization to administer the program.

PM-JAY offers service to 50 crore (500 million) people and is the world's largest government sponsored healthcare program.[4] The program is a poverty alleviation programme as its users are people with low income in India.

History

In 2017 an Indian version of the Global Burden of Disease Study reported major diseases and risk factors from 1990 to 2016 for every state in India.[5] This study brought a lot of interest in government health policy because it identified major health challenges which the government could address.[6]

In 2018 the Indian government described that every year, more than six crores Indians were pushed into poverty because of out of pocket medical expenses.[7] There were various available regional and national programs for healthcare in India.

The Indian government first announced the Ayushman Bharat Yogana as a universal health care plan in February 2018 in the 2018 Union budget of India.[8] The Union Council of Ministers approved it in March. In his 2018 Independence Day speech Prime Minister Narendra Modi announced that India would have a major national health program later that year on 25 September, also commemorating the birthday of Pandit Deendayal Upadhyaya.[9] In June 2018 the applications opened for hospitals through an "empanelment process".[8] In July 2018, the Ayushman Bharat Yojana recommended that people access benefits through Aadhaar, but also said that there was a process for people to access without that identity card.[8] AB PM-JAY was launched on 23 September 2018 at Ranchi, Jharkhand.[10]

Around early 2019 sources which called the program "ambitious" include the World Health Organization,[11] Forbes India,[12] Press Trust of India,[13] the Business Standard,[14] and others.[15]

The National Health Protection Scheme (NHPS) scheme is formed by subsuming multiple schemes including Rashtriya Swasthya Bima Yojana, Senior citizen health Insurance Scheme (SCHIS), Central Government Health Scheme (CGHS), Employees' State Insurance Scheme (ESIS), etc. The National Health Policy, 2017 has envisioned Health and Wellness Centres as the foundation of India's health system which the scheme aims to establish.[16]

The scheme envisions to alleviate the condition of 50 crore poor and vulnerable Indians.

On December 26 2020, Prime Minister Narendra Modi launched the Pradhan Mantri Jan Arogya Yojana Sehat (PM-JAY-SEHAT) which extends the Ayushman Bharat scheme to all residents of the Jammu and Kashmir. The scheme will provide a financial cover of Rs. 5 lakh per family for in-patient care and surgical procedures.[17]

Key Features

Features of PM-JAY include the following:

  • Providing health coverage for 10 crores households or 50 crores Indians.[18]
  • It provides a cover of 5 lakh per family per year for medical treatment in empanelled hospitals, both public and private.
  • Offering cashless payment and paperless recordkeeping through the hospital or doctor's office.[19]
  • Using criteria from the Socio Economic and Caste Census 2011 to determine eligibility for benefits.[20][21]
  • There is no restriction on family size, age or gender.
  • All previous medical conditions are covered under the scheme.
  • It covers 3 days of pre-hospitalisation and 15 days of post-hospitalisation, including diagnostic care and expenses on medicines.
  • The scheme is portable and a beneficiary can avail medical treatment at any PM-JAY empanelled hospital outside their state and anywhere in the country.[22]
  • Providing access to free COVID-19 testing[23][24]

Reach

Participation by states and union territories

India's 28 states and 8 union territories each make their own choice about whether to participate in Ayushman Bharat Yojana.[8] In February 2018 when the program was announced 20 states committed to join.[8] In September 2018 shortly after launch 5 states and territories declined to participate in the program: Delhi, Telangana, Odisha, Kerala, West Bengal and Punjab.[25]

Kerala had its own health program and as of Jun 2019 agreed to begin using Ayushman Bharat Yogana from November 2019.[26][27]

Maharashtra and Tamil Nadu initially declined to join because they each had their own state healthcare programmes.[28] Those programs, Mahatma Jyotiba Phule Jan Arogya Yojana and the programme for Tamil Nadu, were already functioning well. These states later both joined Ayushman Bharat Yojana with special exceptions to make it part of their existing infrastructure.[28]

West Bengal initially joined the program but then opted out in favor of establishing their own regional health programme.[29] Telangana did the same.[30]

By January 2020 Odisha had not joined the scheme.[31]

In March 2020 Delhi announced that it would join the program.[32]

Participation by local people

In May 2020 Prime Minister Narendra Modi said in his radio show Mann Ki Baat that the Ayushman Bharat scheme had recently benefited more than one crore people.[33]

By May 2020, the scheme had provided more than 1 crore treatments with a value of ₹13,412 crore.[34] The number of public and private hospitals empanelled nationwide stands at 24,432.[35]

The Ayushman Bharat Yojana programme announced a special collaboration with the Employees' State Insurance programme in November 2019.[36] From June 2020, the program had entered a pilot to cover 120,000 workers with that insurance at 15 hospitals.[37]

Challenges

When Ayushman Bharat Yojana began there were questions of how to reconcile its plans with other existing health development recommendations, such as from NITI Aayog.[38] A major challenge of implementing a national health care scheme would be starting with infrastructure in need of development to be part of a modern national system.[38] While Ayushman Bharat Yojana seeks to provide excellent healthcare, India still has some basic healthcare challenges including relatively few doctors, more cases of infectious disease, and a national budget with a comparatively low central government investment in health care.[39]

While many government hospitals have joined the program, many private corporate hospitals have not. The private hospitals report that they would be unable to offer their special services at the government low price, even with a government subsidy.[28]

The scheme has faced challenges in form of fraudulent bills. In response, National Health Authority has revoked empanelment of 171 hospitals and imposed a penalty of 4.6 crore. Another 390 hospitals have been issued show cause notice.[40]

There have been media reports of misuse of the Ayushman Bharat scheme by unscrupulous private hospitals through submission of fake medical bills. Under the Scheme, surgeries have been claimed to be performed on persons who had been discharged long ago and dialysis has been shown as performed at hospitals not having kidney transplant facility.[41] There are at least 697 fake cases in Uttarakhand State alone, where fine of Rs one crore has been imposed on hospitals for frauds under the Scheme.[42] However, unlike the earlier RSBY (Rashtriya Swasthya Bima Yojana) era, plagued by lax monitoring of insurance fraud, AB-PMJAY involves a robust information technology infrastructure overseeing transactions and locating suspicious surges across the country. Health Minister Harsh Vardhan has blacklisted hospitals and named them publicly for misconduct.[43] Initial analysis of high-value claims under PMJAY has revealed that a relatively small number of districts and hospitals account for a high number of these, and some hint of an anti-women bias, with male patients getting more coverage. Despite all efforts to curb foul-play, the risk of unscrupulous private entities profiteering from gaming the system is clearly present in AB-PMJAY.[44]

References
  1. https://health.economictimes.indiatimes.com/news/policy/budget-2020-healthcare-gets-rs-69000-crore-rs-6400-crore-for-ayushman-bharat/73833215
  2. "आयुष्मान भारत राष्ट्रीय स्वास्थ्य संरक्षण (नेशनल हेल्थ प्रोटेक्शन) योजना - Ayushman bharat". Infnd. 17 June 2015. Retrieved 28 November 2018.
  3. "About Pradhan Mantri Jan Arogya Yojana (PM-JAY)". pmjay.gov.in. Retrieved 2 March 2020.
  4. "Ayushman Bharat on way to become world's largest free healthcare: Arun Jaitley". The Economic Times. 6 March 2019.
  5. Dandona, Lalit; Dandona, Rakhi; Kumar, G Anil; Shukla, D K; Paul, Vinod K; Balakrishnan, Kalpana; Prabhakaran, Dorairaj; Tandon, Nikhil; Salvi, Sundeep; Dash, A P; Nandakumar, A; Patel, Vikram; Agarwal, Sanjay K; Gupta, Prakash C; Dhaliwal, R S; Mathur, Prashant; Laxmaiah, Avula; Dhillon, Preet K; Dey, Subhojit; Mathur, Manu R; Afshin, Ashkan; Fitzmaurice, Christina; Gakidou, Emmanuela; Gething, Peter; Hay, Simon I; Kassebaum, Nicholas J; Kyu, Hmwe; Lim, Stephen S; Naghavi, Mohsen; Roth, Gregory A; Stanaway, Jeffrey D; Whiteford, Harvey; Chadha, Vineet K; Khaparde, Sunil D; Rao, Raghuram; Rade, Kirankumar; Dewan, Puneet; Furtado, Melissa; Dutta, Eliza; Varghese, Chris M; Mehrotra, Ravi; Jambulingam, P; Kaur, Tanvir; Sharma, Meenakshi; Singh, Shalini; Arora, Rashmi; Rasaily, Reeta; Anjana, Ranjit M; Mohan, Viswanathan; Agrawal, Anurag; Chopra, Arvind; Mathew, Ashish J; Bhardwaj, Deeksha; Muraleedharan, Pallavi; Mutreja, Parul; Bienhoff, Kelly; Glenn, Scott; Abdulkader, Rizwan S; Aggarwal, Ashutosh N; Aggarwal, Rakesh; Albert, Sandra; Ambekar, Atul; Arora, Monika; Bachani, Damodar; Bavdekar, Ashish; Beig, Gufran; Bhansali, Anil; Bhargava, Anurag; Bhatia, Eesh; Camara, Bilali; Christopher, D J; Das, Siddharth K; Dave, Paresh V; Dey, Sagnik; Ghoshal, Aloke G; Gopalakrishnan, N; Guleria, Randeep; Gupta, Rajeev; Gupta, Subodh S; Gupta, Tarun; Gupte, M D; Gururaj, G; Harikrishnan, Sivadasanpillai; Iyer, Veena; Jain, Sudhir K; Jeemon, Panniyamamkal; Joshua, Vasna; Kant, Rajni; Kar, Anita; Kataki, Amal C; Katoch, Kiran; Khanna, Tripti; Khera, Ajay; Kinra, Sanjay; Koul, Parvaiz A; Krishnan, Anand; Kumar, Avdhesh; Kumar, Raman K; Kumar, Rashmi; Kurpad, Anura; Ladusingh, Laishram; Lodha, Rakesh; Mahesh, P A; Malhotra, Rajesh; Mathai, Matthews; Mavalankar, Dileep; Mohan BV, Murali; Mukhopadhyay, Satinath; Murhekar, Manoj; Murthy, G V S; Nair, Sanjeev; Nair, Sreenivas A; Nanda, Lipika; Nongmaithem, Romi S; Oommen, Anu M; Pandian, Jeyaraj D; Pandya, Sapan; Parameswaran, Sreejith; Pati, Sanghamitra; Prasad, Kameshwar; Prasad, Narayan; Purwar, Manorama; Rahim, Asma; Raju, Sreebhushan; Ramji, Siddarth; Rangaswamy, Thara; Rath, Goura K; Roy, Ambuj; Sabde, Yogesh; Sachdeva, K S; Sadhu, Harsiddha; Sagar, Rajesh; Sankar, Mari J; Sharma, Rajendra; Shet, Anita; Shirude, Shreya; Shukla, Rajan; Shukla, Sharvari R; Singh, Gagandeep; Singh, Narinder P; Singh, Virendra; Sinha, Anju; Sinha, Dhirendra N; Srivastava, R K; Srividya, A; Suri, Vanita; Swaminathan, Rajaraman; Sylaja, P N; Tandale, Babasaheb; Thakur, J S; Thankappan, Kavumpurathu R; Thomas, Nihal; Tripathy, Srikanth; Varghese, Mathew; Varughese, Santosh; Venkatesh, S; Venugopal, K; Vijayakumar, Lakshmi; Xavier, Denis; Yajnik, Chittaranjan S; Zachariah, Geevar; Zodpey, Sanjay; Rao, J V R Prasada; Vos, Theo; Reddy, K Srinath; Murray, Christopher J L; Swaminathan, Soumya (December 2017). "Nations within a nation: variations in epidemiological transition across the states of India, 1990–2016 in the Global Burden of Disease Study". The Lancet. 390 (10111): 2437–2460. doi:10.1016/S0140-6736(17)32804-0. PMC 5720596. PMID 29150201.
  6. Bhargava, Balram; Paul, Vinod K (September 2018). "Informing NCD control efforts in India on the eve of Ayushman Bharat". The Lancet: S014067361832172X. doi:10.1016/S0140-6736(18)32172-X. PMID 30219331. S2CID 52189318.
  7. Press Trust of India (17 November 2018). "Medical Expenses Push 6 Crore Indians To Poverty Annually: Top Official". NDTV.
  8. Pareek, Manoj (31 July 2018). "Ayushman Bharat-National Health Protection Mission a way towards Universal Health Cover by reaching the bottom of the pyramid to be a game changer or non-starter". International Journal of Advanced and Innovative Research. 7 (7). doi:10.5281/zenodo.1341912.
  9. Mukherjee, Reema; Arora, Manisha (2018). "India's national health protection scheme: A preview". Medical Journal of Dr. D.Y. Patil Vidyapeeth. 11 (5): 385. doi:10.4103/mjdrdypu.mjdrdypu_109_18. S2CID 169815602.
  10. "PM Modi launches PMJAY- Ayushman Bharat in Ranchi". ANInews. 23 September 2018.
  11. Singh, Poonam Khetrapal (1 October 2018). "Ayushman Bharat: An ambitious set of reforms that should benefit millions of India's poor and vulnerable". www.who.int. World Health Organization.
  12. Meghani, Varsha (23 January 2020). "Is PM Modi's Ayushman Bharat Too Ambitious To Succeed?". Forbes India.
  13. Press Trust of India (15 August 2018). "Ambitious Ayushman Bharat Healthcare scheme to be launched on Sept 25: Modi". ptinews.com. Press Trust of India.
  14. Krishnan, Gina (10 August 2018). "10 key things you must know about Modi's ambitious Ayushman Bharat scheme". Business Standard.
  15. Zodpey, S; Farooqui, HH (April 2018). "Universal health coverage in India: Progress achieved & the way forward". The Indian Journal of Medical Research. 147 (4): 327–329. doi:10.4103/ijmr.IJMR_616_18. PMC 6057252. PMID 29998865.
  16. "Can PM Modi's Ayushman Bharat help healthcare startups scale?", The Economic Times, 25 February 2019
  17. "PM Modi to launch Ayushman Bharat health insurance scheme for residents of Jammu and Kashmir on Dec 26". Hindustan Times. 24 December 2020. Retrieved 26 December 2020.
  18. Our Bureau (23 September 2018). "PM unveils Ayushman Bharat; 50 cr to get health cover of ₹5 lakh". Business Line.
  19. Sharma, Yogima Seth (13 September 2019). "Labour ministry to provide cashless secondary and tertiary medical care services under AB-PMJAY". The Economic Times.
  20. "NHA issues circular advising states to identify eligible PMJAY beneficiaries". The Economic Times. 6 October 2018.
  21. Sharma, Neetu Chandra (10 June 2019). "Govt looks beyond SECC 2011 to include more beneficiaries under Modicare". Livemint. HT Media.
  22. Sharma, Neetu Chandra (26 September 2019). "Over 40,000 people availed portable treatment under Ayushman Bharat". Livemint. HT Media.
  23. Kumar, Rajeev (27 May 2020). "Free COVID-19 testing under PMJAY: NHA to empanel ICMR approved labs". The Financial Express.
  24. Kaul, Rhythma (20 May 2020). "2,000 under treatment, 3,000 tested free for Covid-19 under Ayushman Bharat scheme". Hindustan Times.
  25. Moneycontrol News (24 September 2018). "5 states opted out of Ayushman Bharat: Here's why". Moneycontrol.com.
  26. Press Trust of India (9 June 2019). "Kerala govt joins issue with PM on Ayushman Bharat, says state member of scheme". Business Standard.
  27. Krishnakumar, R. (12 April 2019). "A better option in Kerala". Frontline.
  28. Porecha, Maitri (24 September 2019). "A year on, Ayushman Bharat faces multiple challenges ahead". Business Line.
  29. Khanna, Rohit (8 June 2019). "Ayushman Bharat targets 3 crore beneficiaries if West Bengal rejoins the scheme". The Times of India.
  30. Menon, Amarnath K. (9 September 2019). "Telangana CM rejects Centre's Ayushman Bharat for state medical health scheme". India Today.
  31. Press Trust of India (10 December 2019). "People in Delhi, WB, Odisha, Telangana not getting Ayushman Bharat scheme benefits: Harsh Vardhan". The Economic Times.
  32. Press Trust of India (23 March 2020). "AAP govt will implement Ayushman Bharat scheme in Delhi: Sisodia". The Economic Times.
  33. Tandi, Dev Narayan (31 May 2020). "Prime Minister narendra modi addresses 12th Episode of 'Mann Ki Baat 2.0'". .narendramodi.in.
  34. Kumar, Rajeev (20 May 2020). "Ayushman Bharat-PMJAY crosses new milestone! WhatsApp chatbot, special e-cards planned for celebration". The Financial Express.
  35. "Ayushman Bharat: Fresh push by National Health Agency to get hospitals on board". The Indian Express. 26 November 2018. Retrieved 6 December 2018.
  36. Sharma, Yogima Seth (13 November 2019). "ESIC partners with PMJAY to provide medical facilities to beneficiaries". The Economic Times.
  37. Sharma, Yogima (23 June 2020). "ESIC beneficiaries to soon get facilities of hospital empanelled under Ayushman Bharat". The Economic Times.
  38. Hooda, Shailender Kumar (26 November 2018). "With Inadequate Health Infrastructure, Can Ayushman Bharat Really Work?". The Wire.
  39. Nirula, SR; Naik, M; Gupta, SR (June 2019). "NHS vs Modicare: The Indian Healthcare v2.0. Are we ready to build the healthier India that we envisage?". Journal of Family Medicine and Primary Care. 8 (6): 1835–1837. doi:10.4103/jfmpc.jfmpc_309_19. PMC 6618227. PMID 31334141.
  40. The World, Republic. "171 hospitals de-empanelled, Rs 4.6 Cr penalty levied for committing fraud in PMJAY". Republic World. Retrieved 11 June 2020.
  41. "Ayushman Bharat: Hospitals use Bizarre Ways to Siphon Off Public Funds". The Times of India. 15 August 2019. Retrieved 18 August 2019.
  42. "Hospitals Penalised for Irregularities in Ayushman Bharat Scheme". Hindu Business Line. 25 June 2019. Retrieved 18 August 2019.
  43. Vachhatani, Jitesh (30 September 2019). "Harsh Vardhan's 'name & shame' list to curb frauds under AB-PMJAY". Republic TV.
  44. "Ayushman Bharat – PMJAY at one: A step closer to universal health coverage". ORF. 24 September 2019.

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