Ayushman Bharat Scheme -Pradhan Mantri Jan Aarogya Yojana (PM-JAY)
Post-independence, many initiatives have been taken for policy formulation and their implementation around health financing and efforts have been in determining Universal Healthcare for all in India. Public spending on healthcare has been extremely low and healthcare for all remained a major challenge for policymakers. As per the govt data, India spent only 1.28 per cent of its GDP (2017-18) as public expenditure on health. The figure was 1.02 per cent of the GDP in 2016-17.
About Ayushman Bharat Scheme
Deemed as the largest government-funded healthcare program, the Ayushman Bharat scheme details encompasses more than 10 crore families i.e. more than 50 crore Indian people. The scheme was launched on 25th September- the birth anniversary of Pandit Deendayal Upadhyaya.
Objectives of Ayushman Bharat Yojana:
- To reduce out of pocket expenditure of poor people
- To focus on the wellness of poor families
- To provide the medical benefits to poor families
- To establish health and wellness centres at the nearest distance, so that patients do not have to travel a long distance.
Major highlights of the Ayushman Bharat scheme:
- An insurance cover of Rs 5 Lakh per family per year
- 74 lakh poor & vulnerable families (which roughly translates to 50 crore citizens) entitled as per socio-economic census
- States are given the flexibility to decide on the mode of implementation
- Benefits will be portable across the country
- Around 85% of rural families and 60% of urban families have been identified
The government plans to expand the coverage to primary healthcare by establishing Health and Wellness Centres, but presently it is limited to the cost of secondary and tertiary care. The Ayushman Bharat Yojna is the Insurance model, which was earlier implemented in the form of Rashtriya Swasthiya Bima Yojana (RSBY) that provided a cover of Rs. 30,000 per family per year.
The scheme encompasses the insurance-based model, wherein the role of the government is limited to the payment of premium of the applied insurance and providing medical facilities through empanelled hospitals (free of charge). The cover for the medical cost is typically provided by a third party such as insurance companies.
Ayushman Bharat Scheme Features
- Rashtriya Swasthya Bima Yojana and Senior citizen health insurance scheme cease to exist, and its members would be now covered under PM-JAY.
- The beneficiary can avail the cashless hospitalization with any identity proof not necessarily Aadhar Card but election ID, Ration Card etc.
- Benefits of the scheme are portable across the country and a beneficiary covered under the scheme will be allowed to take cashless benefits from any public/private empanelled hospitals across the country.
- No money is required to be paid by the family in case of hospitalization in public or empanelled private hospitals.
Ayushman Bharat Yojna: National Health Agency (NHA)
Under the Ayushman Bharat Scheme, National Health Agency has also been constituted. The body provides making policies, operational guidelines, creating & implementing mechanism and monitoring the same, coordinating with the state agencies etc.
- Develop partnership and collaborations with the State Govts, insurance and financial agencies, academia, think-tanks, national and international organizations.
- All the empanelled hospitals will have a helpdesk were the beneficiaries.
- The State and Central govt would partner to fund the expenses.
- The NHA is an autonomous body constituted for effective implementation. Also, State Health Agencies are also set up to provide medical benefits.
The Universal Healthcare entails the government is the third-party responsible for the expenditure for all medical facilities availed by an individual as the single-payer, the insurance-based model requires the government as the sole payer only to pay the premiums while the insurance companies act as the third-party payer.
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