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Ayushman Bharat Yojana

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Ayushman Bharat Yojana
Type of projectHealth insurance
CountryIndia
Prime Minister(s)Narendra Modi
MinistryMinistry of Health and Family Welfare
Launched23 September 2018; 6 years ago (2018-09-23)
Budget₹8,088 crore (US$970 million) (2021–22) [1]
StatuscheckY Active
Websitewww.pmjay.gov.in

Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (PM-JAY) (PM-JAY lit. 'Prime Minister's People's Health Scheme', Ayushman Bharat PM-JAY lit. 'Live Long India Prime Minister's People's Health Scheme';) is a national public health insurance scheme of the Government of India that aims to provide free access to health insurance coverage for low income earners in the country. Roughly, the bottom 50% of the country qualifies for this scheme. [2] People using the program access their own primary care services from a family doctor and when anyone needs additional care, PM-JAY provides free secondary health care for those needing specialist treatment and tertiary health care for those requiring hospitalization.[3]

An Urban Primary Health Centre under Ayushman Bharat Yojana in Bidipeth, Nagpur

The programme is part of the Indian government's National Health Policy and is means-tested. It was launched in September 2018 by the Ministry of Health and Family Welfare. That ministry later established the National Health Authority as an organization to administer the program. It is a centrally sponsored scheme and is jointly funded by both the union government and the states. By offering services to 50 crore (500 million) people it is the world's largest government sponsored healthcare program.[4] The program is a means-tested program, considering its users are people categorized as low income in India.[5]

History

In 2017 an Indian version of the Global Burden of Disease Study reported major diseases and risk factors from 1990 to 2016 for every state in India.[6] This study brought a lot of interest in government health policy because it identified major health challenges which the government could address.[7] A large percentage of the population is left underserved by the Indian health system, which relies on out-of-pocket payments from patients to fund care.[8] These payments hinder a lot of patients from being able to receive healthcare services. In 2018 the Indian government described that every year, more than six crores Indians were pushed into poverty because of out of pocket medical expenses.[9] Despite various available regional and national programs for healthcare in India, there was much more to be done. The Indian government first announced the Ayushman Bharat Yojana as a universal health care plan in February 2018 in the 2018 Union budget of India.[10] The Union Council of Ministers approved it in March. In his 2018 Independence Day speech Prime Minister Narendra Modi announced that India would have a major national health program later that year on 25 September, also commemorating the birthday of Pandit Deendayal Upadhyaya.[11]

PM-JAY stamp

In June 2018 the applications opened for hospitals through an "empanelment process".[citation needed] In July 2018, the Ayushman Bharat Yojana recommended that people access benefits through Aadhaar, but also said that there was a process for people to access without that identity card.[citation needed] AB PM-JAY was first launched on 23 September 2018 at Ranchi, Jharkhand.[12] By 26 December 2020 the scheme was extended to the Union Territories of Jammu Kashmir and Ladakh.[13] The program has been called "ambitious".[14][15]

Features

A health and wellness centre established as a part of Ayushman Bharat Yojna at Mahua community development bloc, Bihar.

Features of PM-JAY include the following— providing health coverage to 10 crores households or 50 crores Indians;[16] providing a cover of ₹5 lakh (equivalent to ₹5.6 lakh or US$6,700 in 2023) per family per year for medical treatment in empaneled hospitals, both public and private; offering cashless payment and paperless recordkeeping through the hospital or doctor's office;[17] using criteria from the Socio Economic and Caste Census 2011 to determine eligibility for benefits;[18][19] no restriction on family size, age or gender; all pre-existing medical conditions are covered under the scheme; it covers 3 days of pre-hospitalisation and 15 days of post-hospitalisation, including diagnostic care and expenses on medicines; the scheme is portable and a beneficiary can avail medical treatment at any PM-JAY empanelled hospital outside their state and anywhere in the country;[20] providing access to free COVID-19 testing.[21][22]

In India, rather than focusing on strengthening essential primary, secondary, and tertiary healthcare in the public system, a shift toward an insurance-based system has been promoted.[23] Chronic underfunding of India’s public health sector compared to private sector, and the liberalization of the market for private health insurance by the Indian government in the late 1990s resulted in increased health disparities, as private health insurance is only affordable for higher class, richer communities.[24] In the mid 2000s, government-funded health insurance emerged as a new type of healthcare financing, helping individuals prevent catastrophic out-of-pocket health expenditures.[24] Through this model, the state would pay premiums to private insurers that would allow eligible individuals to receive free treatment at any public or private institution that has joined the PMJAY scheme. The Indian government recognized that individual out-of-pocket expenditures were pushing people into poverty and treatment in government hospitals could not protect people against catastrophic health expenditures.[24] The alternative of government-funded health insurance allows poorer individuals to still be able to access private health care without the extra expenses.[24]

Implementation

Reach

Participation by states and union territories

India's 28 states and 8 union territories each make their own choice about whether to participate in Ayushman Bharat Yojana.[citation needed] In February 2018, when the program was announced 20 states committed to join.[citation needed] In September 2018, shortly after launch some states and territories declined to participate in the program.[25] Maharashtra and Tamil Nadu initially declined to join because they each had their own state healthcare programmes.[26][27] Those programs, Mahatma Jyotiba Phule Jan Arogya Yojana and the programme for Tamil Nadu, were already functioning well. These states later both joined Ayushman Bharat Yojana with special exceptions to make it part of their existing infrastructure.[27] In a similar way, Kerala, despite having its own health program agreed to begin using Ayushman Bharat Yojana from November 2019.[28][29] West Bengal initially joined the program but then opted out in favor of establishing their own regional health programme.[30] Telangana did the same.[31] By January 2020, Odisha had not joined the scheme.[32] In March 2020, Delhi announced that it would join the program.[33]

Participation by local people

In May 2020, Prime Minister Narendra Modi said in his radio show Mann Ki Baat that the Ayushman Bharat scheme had recently benefited more than one crore people.[34] By May 2020, the scheme had provided more than 1 crore treatments with a value of ₹13,412 crore.[35] The number of public and private hospitals empanelled nationwide stands at 24,432.[36] The Ayushman Bharat Yojana programme announced a special collaboration with the Employees' State Insurance programme in November 2019.[37] From June 2020, the program had entered a pilot to cover 120,000 workers with that insurance at 15 hospitals.[38][39]

Challenges

When Ayushman Bharat Yojana (Ayushman Card) began there were questions of how to reconcile its plans with other existing health development recommendations, such as from NITI Aayog.[40] [41] A major challenge of implementing a national health care scheme would be starting with infrastructure in need of development to be part of a modern national system.[40] While Ayushman Bharat Yojana seeks to provide excellent healthcare, India still has some basic healthcare challenges including relatively few doctors, more cases of infectious disease, and a national budget with a comparatively low central government investment in health care. Some of the problems lay outside the Health Ministry such as urban development or transport.[42] While many government hospitals have joined the program, many private corporate hospitals have not. The private hospitals report that they would be unable to offer their special services at the government low price, even with a government subsidy.[27]

There has been misuse of the Ayushman Bharat scheme by private hospitals through submission of fake medical bills. Under the Scheme, surgeries have been claimed to be performed on persons who had been discharged long ago and dialysis has been shown as performed at hospitals not having kidney transplant facility.[43] There are at least 697 fake cases in Uttarakhand State alone, where fine of ₹1 crore (equivalent to ₹1.1 crore or US$130,000 in 2023) has been imposed on hospitals for frauds under the Scheme.[44] Initial analysis of high-value claims under PM-JAY has revealed that a relatively small number of districts and hospitals account for a high number of these, and some hint of an anti-women bias, with male patients getting more coverage. Despite all efforts to curb foul-play, the risk of unscrupulous private entities profiteering from gaming the system is clearly present in PM-JAY.[45]

References

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  2. ^ "आयुष्मान भारत राष्ट्रीय स्वास्थ्य संरक्षण (नेशनल हेल्थ प्रोटेक्शन) योजना - Ayushman bharat". Infnd. 17 June 2015. Retrieved 28 November 2018.
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  5. ^ "About PM-JAY - National Health Authority | GOI". nha.gov.in. Retrieved 4 January 2024.
  6. ^ Dandona, Lalit; Dandona, Rakhi; Kumar, G Anil; Shukla, D K; et al. (December 2017). "Nations within a nation: variations in epidemiological transition across the states of India, 1990–2016 in the Global Burden of Disease Study". The Lancet. 390 (10111): 2437–2460. doi:10.1016/S0140-6736(17)32804-0. PMC 5720596. PMID 29150201 – via NCBI.
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  37. ^ Sharma, Yogima Seth (13 November 2019). "ESIC partners with PMJAY to provide medical facilities to beneficiaries". The Economic Times. Archived from the original on 20 April 2021.
  38. ^ Sharma, Yogima (23 June 2020). "ESIC beneficiaries to soon get facilities of hospital empanelled under Ayushman Bharat". The Economic Times.
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  40. ^ a b Hooda, Shailender Kumar (26 November 2018). "With Inadequate Health Infrastructure, Can Ayushman Bharat Really Work?". The Wire. Archived from the original on 27 November 2018.
  41. ^ "Ayushman Card".
  42. ^ Nirula, SR; Naik, M; Gupta, SR (June 2019). "NHS vs Modicare: The Indian Healthcare v2.0. Are we ready to build the healthier India that we envisage?". Journal of Family Medicine and Primary Care. 8 (6): 1835–1837. doi:10.4103/jfmpc.jfmpc_309_19. PMC 6618227. PMID 31334141.
  43. ^ "Ayushman Bharat: Hospitals use Bizarre Ways to Siphon Off Public Funds". The Times of India. 15 August 2019. Retrieved 18 August 2019.
  44. ^ "Hospitals Penalised for Irregularities in Ayushman Bharat Scheme". Hindu Business Line. 25 June 2019. Retrieved 18 August 2019.
  45. ^ "Ayushman Bharat – PMJAY at one: A step closer to universal health coverage". ORF. 24 September 2019.
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