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Ayushman Bharat

  • Category
    Polity & Governance
  • Published
    29th Sep, 2018
  • Prime Minister rolled out the centre’s flagshipAyushman Bharat which includes National Health Protection Scheme renamed as Pradhan Mantri Jan Aarogya Yojna (PMJAY)and Health and Wellness Centres (HWCs).
  • The scheme will subsume two ongoing centrally sponsored health insurance schemes namely RashtriyaSwasthyaBimaYojna(RSBY) and the Senior Citizen Insurance Scheme(SCHIS)

Issue

Context

  • Prime Minister rolled out the centre’s flagshipAyushman Bharat which includes National Health Protection Scheme renamed as Pradhan Mantri Jan Aarogya Yojna (PMJAY)and Health and Wellness Centres (HWCs).
  • The scheme will subsume two ongoing centrally sponsored health insurance schemes namely RashtriyaSwasthyaBimaYojna(RSBY) and the Senior Citizen Insurance Scheme(SCHIS)

About

  • Ayushman Bharat is an integrated approach covering primary, secondary and tertiary healthcare through
    aAccess to Health and Wellness centres(HWCs) at the primary healthcare level.
  • These centres will provide Comprehensive Primary Health Care (CPHC).
  • HWCs will cover both maternal and child health services, and non-communicable diseases, including free essential drugs and diagnostic services.
    b. Financial protection for accessing curative care at the secondary and tertiary levels through PMJAY.

Background

  • As per 71st Round of National Sample Survey Organization (NSSO), 85.9% of rural households and 82% of urban households have no access to healthcare insurance/assurance.
  • More than 17% of Indian population spend at least 10% of household budgets on health services.
  • Catastrophic healthcare related expenditure pushes families into debt. More than 24% households in rural India and 18% population in urban areameet their healthcare expenses through some sort of borrowings.
  • To target the situation, in tandem with National Health Policy 2017 goals, central government in Union Budget 2018-19 announced two major initiatives as a part of Ayushman Bharat Programme, namely PMJAY and HWCs.

Mainfeatures of PMJAY:

  • Insurance: NHPS will cover over 10 crore poor and vulnerable families providing coverage upto 5 lakh rupees per family per year for secondary and tertiary care hospitalization through a network of Empanelled Health Care Providers (EHCP).
  • Premium costs for the scheme are expected to be shared between the Centre and each State in a 60-40 ratio, with States expected to voluntarily opt into the scheme.
  • Target: PMJAY primarily targets the poor, deprived rural families and identified occupational category of urban workers’ families as per the latest Socio-Economic Caste Census (SECC) data for both rural and urban areas.
  • Entitlement: PMJAY will be an entitlement based scheme where it will be decided on the basis of deprivation criteria in the SECC database.
  • Inclusions: PMJAY will cover medical and hospitalisation expenses for almost all secondary care and most of tertiary care procedures.
  • The scheme is creating a cadre of certified frontline health service professionals called PradhanMantriAarogyaMitras (PMAMs) who will be primary point of facilitation for the beneficiaries to avail treatment at the hospital.
  • Access: The EHCP network will provide cashless and paperless access to services for the beneficiaries at the both public and private hospitals.
  • States role:The scheme is principle based rather than rule based, allowing States enough flexibility in terms of packages, procedures, scheme design, entitlements as well as other guidelines.
  • States can implement the scheme through an insurance company or directly through the Trust/Society/Implementation Support Agency or a mixed approach.
  • Council: There will be a council at the centre to monitor the scheme at national level.

 

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