Ayushman Bharat: Check Features and Implementation Strategy

By : Neha Dhyani

Updated : Jan 25, 2022, 19:01

Ayushman Bharat, also known as the national initiative 'Healthy India', was launched as part of the 2017 National Health Policy by Prime Minister Narendra Modi to realize the vision of Universal Health Coverage (UHC). This initiative was designed to enable the SDGs' emphasis on 'no one left behind. Ayushman Bharat Yojana is all about a comprehensive needs-based healthcare transition. Ayushman Bharat Pradhan Mantri Jan Arogya Yojana or AB PMJAY is also known as Ayushman Bharat National Health Protection Scheme.

It is a national public health insurance fund run by the Government of India and aims to provide low-income people with free access to health insurance. The bottom 40% of India are eligible for this program. Individuals using the program can access their primary care services through their physicians. PMJAY provides free secondary care to those in need of specialized treatment and tertiary care to those in need of hospitalization.

Serving 500 million people covering up to Rs. 5 lakhs per year per family, this has become the world's largest government-sponsored health program.

Outstanding Features of Ayushman Bharat

  1. The benefits of the Ayushman Bharat card are transferable nationwide, and beneficiaries covered by the scheme can receive cashless benefits from public/private hospitals.
  2. The Ayushman Bharat Yojana is an entitlement-based program based on the SECC database.
  3. Beneficiaries can use the service in both public and private institutions.
  4. To keep costs down, treatment costs are paid at a flat rate which is predetermined by the government.
  5. One of the core principles of the scheme is collaborative flexibility and federalism to the state.
  6. Ayushmann Bharat will be chaired by the Federal Minister of Health and Family to provide policy guidance and facilitate coordination between the centre and the state.
  7. Each state must have a State Health Agency (SHA) to implement the program.
  8. To ensure that funds reach SHA on time, funds can be sent directly from the central government to state health authorities via an escrow account.

Implementation Strategy of Ayushman Bharat

  1. Ayushman Bharat is established at the national level. The state/UT recommends that the program be conducted through a specialized institution called the State Health Agency (SHA). They can use an existing Trust/Corporate/Nonprofit/Government Node Agency (SNA) or create a new organization to implement the program.
  2. A State/UT can choose to implement the system directly through a trust/company, an insurance company, or an integrated model.
  3. PMJAY has curated 1,350 medical packages that comprise medical and daycare treatments like surgery, diagnosis, medication, and transportation.
  4. To ensure that no one (especially girls, women, children, the elderly) is left behind, there is no limit to the number and age of families in the mission.
  5. This system will be cashless and paperless in public and private hospitals.
  6. Eligible beneficiaries do not have to pay hospitalization fees. Benefits include pre-and post-hospital expenses.

Only a healthy nation can withstand global competition. Many government-sponsored health systems have been introduced in recent years to ensure affordable medical care for all sections of the population.

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FAQs about Ayushman Bharat

Q.1. Does Ayushman Bharat National Health Protection Mission include any other system?

Yes. Ayushman Bharat includes the ongoing centrally funded systems Senior Citizen Health Insurance System (SCHIS) and Rashtriya Swasthya Bima Yojana (RSBY).

Q.2. What is the role of Niti Aayog in Ayushaman Bharat?

NITI Aayog has played a significant role in strengthening the Ayushman Bharat Scheme. It held extensive peer review of health benefits packages for PMJAY and recommended 1352 packages. Its recommendations included adding packages on emergency room packages and mental care packages, etc. NITI also suggested measures for incentivizing healthcare quality and service uptake in Aspirational districts through the development of Standard Treatment Workflow and Costing for Health Benefit Packages.

Q.3. What are the deprivation criteria to identify rural families eligible for Ayushman Bharat Registration?

There are six deprivation criteria eligible for the benefit from the program:

  1. Families that have no adults between the ages of 16 and 59.
  2. A female member between the ages of 16 and 59 without an adult male member running the household.
  3. Single room households with temporary walls and roofs.
  4. Households that belong to the SC/ST category.
  5. Households with disabled members who do not have competent members to provide support.
  6. Landless households that engage in manual labour as a source of basic income.

Q.5. Which households are automatically eligible for Ayushman Bharat?

Destitute families on alms, manual scavengers' families, families without proper shelter, bonded labourers, and those belonging to vulnerable tribal groups are automatically eligible for this scheme.