Ayushman Bharat UPSC – Benefits, HWCs, PMJAY, Components, Challenges

By BYJU'S Exam Prep

Updated on: November 14th, 2023

Ayushman Bharat is a protection health program initiated by the Prime Minister of India in 2018. The Government of India launched this scheme to address health problems at primary, secondary, and tertiary stages. The Ayushman Bharat scheme is the Indian Government’s flagship initiative as per the recommendation of the National Health Policy, 2017, to attain the foresight of Universal Health Coverage (UHC). It emphasizes the promise of not overlooking anyone. It was designed to achieve sustainable development goals.

Ayushman Bharat scheme is a unified and comprehensive methodology encompassing health insurance covers and healthcare services at all levels. Aspirants preparing for the UPSC Exam must thoroughly go through the Ayushman Bharat scheme and understand its basic aspects and components. Covering the topic in detail will help greatly in the upcoming IAS Exam. Ayushman Bharat will cover prevention, encouragement, and ambulant care at all levels.

What is Ayushman Bharat?

Ayushman Bharat is also known as National Health Protection Scheme, it is a health program initiated in 2018 by the Government of India. Prime Minister Narendra Modi’s healthcare scheme for the country’s people aims to upgrade and enhance the quality of the healthcare system in India. Moreover, this comprehensive healthcare program endeavors propel to move ahead in the healthcare sector from a sectoral and segmented methodology to all-inclusive requirement-based healthcare services. This scheme is typically categorized into two components:

  • Pradhan Mantri Jan Arogya Yojana
  • Health and Wellness Centres

While the first component of Ayushman Bharat, the Pradhan Mantri Jan Arogya Yojana, comprises financial security for benefiting healthcare facilities at the secondary and tertiary stages. On the other side, the second component Health and Wellness Centres aims to improve the accessibility of affordable and excellent quality healthcare facilities at the primary stage. It is the most extensive government-financed healthcare program globally, with more than 50 million beneficiaries. The scheme is also labeled Modicare’ in the name of Indian Prime Minister Narendra Modi.

Objectives of the PM Ayushman Bharat Mission

The PM Ayushman Bharat mission is one of the largest health schemes ventured across India to enhance healthcare infrastructure. Prime Minister Narendra Modi initiated this mission to create and devise a long-term public healthcare network. Here are the major objectives behind starting the PM Ayushman Bharat Health Infrastructure Mission.

  • To enhance and better public health institutions by providing universal, all-inclusive primary health care and critical care assistance and excellent structures for diagnostics and cure.
  • Creating an extensive network of surveillance labs at national, regional, district, and block levels for effectively investigating, diagnosing, averting, and fighting disease outbreaks and public health emergencies.
  • Another vital aspect it focuses on is COVID-19; it states that there should be thorough research on the pandemic and other diseases so that the country develops the main potential to provide the One Health Approach to avert, investigate and cater to the outbreak of the infectious diseases in both humans and animals.

Need for Ayushman Bharat Scheme

The National Sample Survey Organization brought out several devastating and shocking facts about the healthcare system in India in its 71st survey round. The survey revealed that around 86 percent of countryside households and 82 percent of urban households have no reach or knowledge of healthcare insurance.

  • More than 17 percent of the population in India spends a minimum, around 1/10th of their domestic budget, on good healthcare services.
  • More than 19 percent of metropolitan families and about 24 percent of rural families collect money for their healthcare funding requirements through borrowings or money lending. Unfortunately, this approach and casual attitude toward healthcare and sudden and critical health problems often put many families into moderate to heavy debt.
  • Therefore, incorporating National Health Policy, the Prime Minister has initiated this Ayushman Bharat scheme with two sub-components, HWCs, and PM-JAY. The scheme was launched in 2018 to tackle the above-discussed grim concerns for healthcare.

Components of the Ayushman Bharat Scheme

The primary aim of the mission is to bring an ideal transformation in India’s healthcare system infrastructure and make it stronger by offering a high-class testing network for the effective investigation and prevention of diseases. The Ayushman Bharat Scheme was launched with two components for addressing various healthcare concerns at all levels:

  • Pradhan Mantri Jan Arogya Yojana
  • Health and Wellness Centres.

Pradhan Mantri Jan Arogya Yojana (PM-JAY)

It is commonly known as PM-JAY, the most striving and extensive health sector scheme in India and the world’s biggest health insurance scheme financed by the Government. Initially, it was commenced as the National Health Protection Mission but was retitled as PM-JAY.

  • Under this scheme, eligible families receive a health insurance fund of 5,00,000 INR annually.
  • The Government of India has proposed the amount of 5 Lakhs remembering all the secondary stage and maximum tertiary stage healthcare expenses that could be incurred by any family.
  • The scheme does not have any restrictions on people’s age and the size of the beneficiary family because it emphasizes the commitment of not avoiding any eligible individual in the country.
  • This scheme’s healthcare insurance covers all the overheads of future health problems and the pre-hospitalization and post-hospitalization overheads. Additionally, it covers expenditures for pre-existing health conditions.
  • Health insurance under PM-JAY includes three-day pre-hospitalization expenses and post-hospitalization expenses of 15 days comprising several diagnostics and medications.
  • The scheme also covers an actual transport expense per hospital for the beneficiary families.
  • Most importantly, the scheme allows the beneficiary families to receive cashless treatment from any impaneled hospital (comprising public and private healthcare centers) located in any corner of the country.

Other elements of treatment included under the PM-JAY scheme are:

  • Medical check-ups, doctors’ consultations, and treatment.
  • Medications & Drugs.
  • Medical implant services.
  • Additional medical consumables.
  • ICUs and non-ICU facilities.
  • Laboratory and diagnostic examinations.
  • Health problems resulting from the treatment.
  • Food and accommodation facilities.

Health and Wellness Centres (HWCs) under Ayushman Bharat Yojana

The Health and Wellness Centres (HWCs) are other vital components of the Ayushman Bharat Scheme. They were developed by transforming the already prevailing primary healthcare centers and subcentres. Introducing these HWCs provides people with Comprehensive Primary Health Care (CPHC) consisting of children and maternal healthcare facilities, non-contagious ailments or infections, diagnostic services, and free vital medicines.

  • These healthcare centres are necessary and crucial for the country’s people as they provide CPHC, essential to boosting health outcomes.
  • Moreover, several diseases can be treated and prevented with effective primary healthcare; thus, making CPHC accessible can significantly help decrease illness and mortality at a lower expense and prominently diminishes the need for secondary and tertiary healthcare.

Healthcare facilities provided by Healthcare and Wellness Centers are:

  • Healthcare during pregnancy and childbirth.
  • Medical and health care for infants, children, and teenagers.
  • Consultation for contraceptive planning a family and reproductive medical care facilities.
  • Supervise and control contagious diseases incorporating NHPs.
  • Supervise and control common contagious diseases, and medical care to patients with small injuries and common ailments.
  • Diagnosing, preventing, and controlling non-contagious diseases.
  • Primary Oral Care Facilities.
  • Comforting healthcare for elderly people.

Benefits of Ayushman Bharat Scheme

Through the Ayushman Bharat scheme, the Government of India aims to upgrade and enhance the quality of the healthcare system in India, incorporating prevention, encouragement, and ambulant healthcare at all levels. The benefits of the scheme include:

  • The scheme can effectively streamline access to wide-ranging healthcare involving early diagnostics and treatment facilities by the large section of the Indian population who otherwise might not pay for these medical facilities.
  • Moreover, the Nation Health Protection Scheme might aid the nation in advancing universal health coverage and equitable access to healthcare facilities. It is one of the United Nations’ several sustainable development goals.
  • The HWCs developed incorporation with the Ayushman Bharat scheme can also play an anticipatory role by decreasing the frequency and effect of non-contagious diseases.
  • Also, the recommended NHPS might be the predecessor to the Universal Insurance Scheme that will incorporate all citizens for healthcare insurance.

Diseases Covered in Ayushman Bharat Yojana

The Ayushman Bharat Yojana was founded to provide medical benefits to the deprived groups of society. The scheme offers healthcare coverage of Rs. 5 lahks per family annually. The scheme offers 1,400 medical practices at any public or private hospital across India. PMJAY covers the following critical ailments:

  • Pulmonary valve surgery.
  • Double valve replacement surgery.
  • Laryngopharyngectomy with gastric pull-up.
  • Anterior spine fixation.
  • Carotid angioplasty with stent.
  • Prostate cancer.
  • Coronary artery bypass grafting.
  • Skull base surgery.
  • Tissue expander for disfigurement following burns.
  • COVID-19 treatment and testing.
  • Specific cancer and orthopedics treatment.

Characteristics of Ayushman Bharat Scheme

The 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. The characteristics of the scheme are-

  • This government-financed health insurance program provides no-cost insurance coverage of up to 50,00,00 INR annually to every beneficiary family. This health insurance can be availed at any government or public healthcare center or any impaneled private healthcare center in any region of India for secondary and tertiary healthcare services.
  • Also titled Modicare,’ the program is open for 74,00,00,000 beneficiary families and approximately 50,00,00,000 Indian citizens. Under this course, 80% of recipients in rural and urban areas are identified based on the data released by (SECC).
  • The Ayushman Bharat scheme does not have any constraints on the age or gender of the recipients and the number of members in the beneficiary family.
  • Unlike other health insurance schemes, Ayushman Bharat has no waiting duration for pre-existing diseases. The insurance coverage under this scheme includes all the conditions from the first day of receiving the Ayushman Bharat policy. Also, the benefit covers expenses in the pre and post-hospitalization stages.
  • The Central and State governments share the expenses incurred in particular payments. All the Indian states and UTs fund the scheme in a ratio of 60:40 with their legislature. While the Northeast states, Himachal Pradesh, Uttarakhand, and J&K fund the scheme in a 90:10 ratio, the central Government bears this funding expense for Union territories not having a legislature.
  • The National Health Protection Mission uses a strategic approach to purchasing from government and private healthcare centers and pays the hospitalization expenses of the beneficiary families.
  • The NHPS extracts supplementary resources through the Health and Education sectors. Additionally, it changes with state funding to increase the central Government’s allocation. The insurance premiums are anticipated to range between 1,000 and 1,200 per year.
  • The 1,50,000 sub-centers transformed into HWCs accommodate the majority of services such as diagnosing and treating cardiac or heart-related diseases, screening for cancers or tumours, mental healthcare services, elderly healthcare, eye care facilities, and many other services.
  • The HWCs will also provide people with a comprehensive range of services incorporating pregnancy and childcare facilities and vaccinations to prevent a few specific infectious diseases.

Eligibility Criteria for PM-JAY

PM-JAY – Ayushman Bharat is a privileged-based program. The eligible families for the scheme’s benefit are decided on deprivation as per the SECC database. The following categories of families are eligible for the benefits of this scheme:

  • Families living in one-room and kitchen homes.
  • Families with no adult members aged between 16 and 59.
  • Families in which female members lead the household with no adult male between 16 and 59.
  • Families with no capable adult members to take care of disabled members.
  • Families belong to SC/ST sections.
  • Landless families obtain a significant portion of their livelihood from manual labour.
  • Families in rural areas with shelter-less houses are deprived, live on charities, do manual hunting, primitive tribes, and legally liberated forced labour.
  • Families in urban areas involved in the following occupations are eligible for this scheme: Household work, ragpicking, and begging, street vending, hawking, shoe making, or providing any other street services. Plumbers, labourers, masons, and construction workers, Security guards, welding workers are also eligible. Head load workers like Coolies, and sanitation workers. Artists, tailors, painters, and other craft workers. Transport workers like drivers, conductors, and rickshaw pullers. Shop workers such as waiters, delivery assistants, and helpers. Mechanics, Washermen, Electricians, and other repair workers.

Moreover, families with motor vehicles, boats, refrigerators, landlines, and families having an earning member who earns above 10,000 INR monthly, families with government servants, families owning some land, and families paying income tax cannot get benefits of the scheme according to SECC’s data.

Do we have Infrastructure for the Ayushman Bharat Digital Mission?

The Indian Government has formulated the Ayushman Bharat digital mission to improve access to quality healthcare for every citizen. A holistic healthcare program will be designed to include all key stakeholders.

  • Our present public digital infrastructure can support the successful implementation of the Ayushman Bharat digital mission. This platform enables digital signatures, paperless payments, digital record storage, and electronic signatures.
  • The success of the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana in providing end-to-end solutions from admission to discharge in hospitals, including paperless payments, can be used as a model for this mission.
  • A holistic healthcare system that provides equitable access to healthcare can be created through emerging technologies like AI (Artificial Intelligence) and IoT (Internet of Things).

Challenges of Ayushman Bharat Scheme

Although the Ayushman Bharat Scheme aims to address health problems at different levels in the country, there are some challenges and obstacles that it faces.

  • The first and foremost challenge is that most hospitals and healthcare centers suffer from a major shortage of doctors and specialists.
  • Secondly, the public healthcare sector must address the situation of human resources to improve and compete with the private sector. This is crucial because the Ayushman Bharat Scheme is targeted at the poor population that only has access to public health centers.
  • Since there is an uneven distribution of human resources at various healthcare levels, almost 40% of positions are lying vacant in many states.
  • Lastly, the NHPS scheme or Ayushman Bharat Yojana has failed to address the broken system of healthcare in the country.

Ayushman Bharat UPSC Notes

Ayushman Bharat Scheme is an essential topic for UPSC Prelims and Mains. To prepare for this topic, one must be well aware of Current Affairs and recent happenings. Students must remember that this topic might also be asked in the IAS Essay Topics.

Ayushman Bharat Scheme UPSC PDF

The aspirants who are going to appear for the IAS exam must refer to the UPSC Syllabus to understand the exam pattern better. Aspirants should also practice the previous year’s question papers and refer to other study materials.

Ayushman Bharat Sample Question

The Ayushman Bharat digital mission was launched in 2021 so that the healthcare system in India has a more ‘citizen-centric approach’. Citizens need to own their health data, and a holistic IT-based healthcare program was required for this purpose. Easier access to health services had to be provided. The candidates can practice the below-mentioned question in order to get hold of the topic as elaborated here.

Question: Which of the below-mentioned statements are true concerning the Government of India’s Ayushman Bharat – PM-JAY scheme? [1] The PM-JAY is one of the components of the Ayushman Bharat Yojana. [2] The PM-JAY is the world’s most extensive healthcare insurance scheme

Choose the Correct Answer: [A] Only 2 is true,  [B] 1 is false, but 2 is true, [C] Both 1 and 2 are true, [D] 1 is true, but 2 is false

Answer: C The PM-JAY is one of the components of the Ayushman Bharat Yojana. The PM-JAY is the world’s most extensive healthcare insurance scheme.

Question: In accordance with the Ayushman Bharat Digital Mission, consider the following statements: [1]. Public and Private Hospitals must adopt it. [2] The main objective of Universal Health coverage, is the Indian citizen must be associated with it. [3] It has flawless accessibility across the country.

Which of the statements is correct? [A] 1,2 only [B] 1 and 3 only [C] 3 only [D] 1,2 and 3

Answer: Option [C] 3 Only [It has flawless accessibility across the country].

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