Relevance: GS Paper II (Development and Welfare)
Introduction
Ayushman Bharat is a far-reaching initiative aimed at ensuring holistic healthcare services.
Components of Ayushman Bharat
- It’s first component involves expansion of services with elements of promotive and preventive healthcare under comprehensive primary health through health and wellness centers.
- It’s second component is the health assurance mission addressing concerns of catastrophic expenditure by vulnerable families for secondary and tertiary care, the Pradhan Mantri Jan Arogya Yojana (PMJAY). It will provide a cover of Rs 5 lakh per family per year for inpatient care to 10.74 crore families at the bottom of the pyramid.
Features of Ayushman Bharat
- The services will be provided by empaneled public and private hospitals.
- Unlike private insurance schemes, PMJAY does not exclude a person on account of pre-existing illnesses.
- The size of the family is no bar.
- There is also no need for formal enrollment; families that are listed with defined deprivation criteria on the Socio Economic and Caste Census database are automatically enrolled.
- All that is required is a proof of identity, which could be Aadhaar or any other government-issued identity card.
- All but a few states have agreed to be a part of the PMJAY.
- A strong fraud control mechanism has been conceived.
- An audit system has been put in place.
- Thousands of Ayushman Mitras are being trained. At each facility, one of them will receive the beneficiary, check her eligibility and facilitate in-patient care.
- A system for patient feedback and grievance redressal is also in place.
- The system will be cashless and largely paperless.
- The Yojana will be implemented in concord with state-level schemes, if they exist.
- An autonomous and empowered National Health Agency (NHA) has been established with corresponding state level health agencies (SHAs).
- A robust IT system has been put in place.
- An efficient claims management system is functional with payments to be made within two weeks.
- One unique feature of the PMJAY is its national portability once fully operational. If a beneficiary from Jharkhand falls sick in Uttar Pradesh (UP), she is entitled to receive treatment in any of the empanelled hospitals in UP. Her home state will make the requisite payment for the services availed.
A new era
- PMJAY will herald a new era in healthcare for four reasons.
- First, it will dramatically improve provision of healthcare for the poor. For instance, it is now possible for a construction worker with an injured knee to have an implant for free..
- Second, the PMAJAY will be a catalyst for transformation. It will be an enabler of quality, affordability and accountability in the health system. Another impact of the PMJAY will be rationalization of the cost of care in the private sector.
- Third, the PMJAY is a poverty-reducing measure. Each year, six to seven crore people, above the poverty line, fall below it because of health-related expenses. PMJAY would reduce this number significantly.
- Fourth, the scheme will create lakhs of jobs for professionals and non-professionals — especially women. It will give a boost to the health technology industry.
Way forward
The implementation of a mission of this size, ambition and complexity is hugely challenging. High uptake, quality care, beneficiary satisfaction, efficient operations and fraud-controlled systems are the key metrices of its success.
Conclusion
With highly competent and dedicated teams at the NHA and SHAs, backed by the highest political will and the goodwill of the people, the PMJAY is poised to deliver on its promise.
