Shivendra Shandilya
Ayushman Bharat Pradhan Mantri Jan Arogya Yojana which provides insurance cover of Rs 5 lakh per year to 10.74 crore poor and vulnerable families, gives access to secondary and tertiary healthcare. Its total coverage of more than 50 crore people is greater than entire population of European Union.
The health insurance is an important cornerstone of the social security schemes and one of the contemporary challenging issues of policy making in the 21st century. The health coverage to citizen is a form of human capital investment made by any country who wishes its return in form of economic prosperity and stability. In 2010, USA President Barack Obama signed Affordable Care Act (ACA), which made global headline, is one of the prime examples of the necessity of proverb “Health Is Wealth” in a nation’s policy making framework. India rolled down National Health Policy (NHP) in 2017 with Universal Health Care (UHC). The national sample survey (NSS) on social national consumption related to health conducted in 75th round (July 2017-June 2018) reveals that 80 percentage out of total population do not have any health insurance.
On 23rd September 2018, PM Modi launched a landmark world’s largest health Insurance scheme “Ayushman Bharat Yojana” which provides insurance cover of Rs 5 lakh per year to 10.74 crore poor and vulnerable families. This scheme gives access to secondary and tertiary healthcare. It covers population of more than 50 crore which is greater than entire population of European Union. The rural and urban families both are beneficiary under Social-Economical Caste Census (SECC) of 2011. Convergence of earlier central government schemes like Rastriya Suraksha Bima Yojana (RSBY) and Employee State Insurance Corporation (ESIC) comes under its ambit. The extension of scheme with additional cover of families under various state sponsored health insurance schemes increased the total beneficiaries to 13.2 crore families.
The Ayushman Bharat is officially known as Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB PM-JAY) is mainly based on two pillars:
1. Establishment of health & wellness centre: The creation of 1,50,000 health & wellness centres (HWC) by 2022 will bring health care closer to people. It will include health care services related to child and maternity, non-communicable diseases, palliative, rehabilitative care, oral, ENT care, mental health and first level care for emergencies and trauma including free essential drugs and diagnostic services.
2. PM – JAY cards: The greatest way to achieve universal health coverage and sustainable development goal (SDG-3) is by mainstreaming the people who are left behind on parameters of human development index. The categories of population that will be covered in rural and urban under PM-JAY is vast and comprehensive.
The PM-JAY has expanded access to more than 22000 hospitals impaneled across the nation (public, private and others) with more than 1 crore treatment worth more than Rs.13500 crore mostly spent on tertiary care with cashless access to hospitalization services. As of now, more than 12 crore beneficiaries have received their health card. The new health benefit packages under this scheme provides 1578 procedures consisting of surgical, medical and unspecified ones. It covers cost of hospitalization, treatment up to 3 days of pre-hospitalization and 15 days of post-hospitalization follow up care.
The best part of the scheme is monitoring and tele-consultation with beneficiary feedback system which helps in receiving constant feedback from patients on ground directly. the website and mobile apps are user friendly giving latest data and also resolving concern through toll free number and WhatsApp chat. National Health Authority (NHA) is apex body responsible for implementing this flagship scheme. Dr. Indu Bhushan, CEO of NHA said “The key feature of the scheme is portability that people from any state can be treated in any part of the country and no cap on size of family members, age, gender and pre – existing condition which is improvement from past government schemes” (1st AAROGYA DHARA webinar on occasion of celebration of 1 crore treatments).
The scheme proved to be very instrumental in fight against Covid19 by inclusion of testing and treatment packages. Till now, more than 3000 testing and 2000 treatments have been availed during this pandemic period. The number of health card holders is going to increase as states are encouraging people to get maximum benefits out of it.
India spends only 1.28% of its GDP (2017-18) on public health care which is even less when compared to lower income countries (as reported by National Health Profile 2019). Though states’ expenditure contribution on health is more than central government, for strengthening this scheme, the government needs to spend more on our health care system and also to make this ambitious scheme more holistic and accessible to citizens. India is heavily dependent on import for medical equipment. The time is right to encourage domestic medical device manufacturing by looking at the demand and market size surge in the past years. Amid Covid19 crisis, Indian start-ups and auto sector joined hand for manufacturing of life supporting ventilators and massive production of Personal Protection Equipment (PPE) which is a testimony of domestic industry potential. Ministry of Ayurveda, Yoga and Naturopathy, Unani, Siddha and Homeopathy (AYUSH) have also proposed some treatment under the scheme.
The checking on monetary frauds transaction through fake treatment and billing under the scheme will remain a key challenge in its implementation. The budget allocation and sharing pattern ratio between states under insurance, trust and mixed mode is one of the components of friction between centre and state governments. Presently three states are yet to sign MoU, while West Bengal has regrettably withdrawn from the scheme.
Recently AB PM-JAY has crossed the milestone of 1 crore treatment later this month. The people benefited in the last 20 months have responded very positively through the feedback system which speaks volumes about the success rate of implementation of this scheme by Narendra Modi government.