Ayushman Bharat Yojana
|Ayushman Bharat Yojana|
|Prime Minister(s)||Narendra Modi|
|Launched||23 September 2018|
Ayushman Bharat Yojana or Pradhan Mantri Jan Arogya Yojana (PMJAY) or National Health Protection Scheme is a centrally sponsored scheme launched in 2018, under the Ayushman Bharat Mission of MoHFW in India. The scheme aims at making interventions in primary, secondary and tertiary care systems, covering both preventive and promotive health, to address healthcare holistically. It is an umbrella of two major health initiatives namely, Health and Wellness centres and National Health Protection Scheme (NHPS). Indu Bhushan is the Chief Executive Officer (CEO) and Dr Dinesh Arora as the Deputy CEO of Ayushman Bharat Yojana.
The National Health Protection Scheme (NHPS) scheme is formed by subsuming multiple schemes including Rashtriya Swasthya Bima Yojana, Senior citizen health Insurance Scheme (SCHIS), Central Government Health Scheme (CGHS), Employees' State Insurance Scheme (ESIS), etc. The National Health Policy, 2017 has envisioned Health and Wellness Centres as the foundation of India’s health system which the scheme aims to establish.
The Central Government Health Scheme (CGHS) was started under the Indian Ministry of Health and Family Welfare in 1954 with the objective of providing comprehensive medical care facilities to Central Government employees, pensioners and their dependents residing in CGHS covered cities. This health scheme is now in operation with cities such as Bhubaneswar, Bhopal, Chandigarh, and Bangalore. The dispensary is the backbone of the Scheme. Instructions on these various matters have been issued from, time to time for the guidance of specialists and medical Officers. The Central Government Health Scheme offers health services through Allopathic and Homeopathic systems as well as through traditional Indian forms of medicine such as Ayurveda, Unani, Yoga and Siddha.
Ayushman Bharat consists of two major elements.
1. National Health Protection Scheme
- Ayushman Bharat-National Health Protection Scheme, which will cover over 10 crore (one hundred million) poor and vulnerable families (approximately 50 crore (five hundred million) beneficiaries) providing coverage up to 5 lakh rupees ($7,100) per family per year for secondary and tertiary care hospitalization.
- Benefits of the scheme are portable across the country and a beneficiary covered under the scheme will be allowed to take cashless benefits from any public or private empaneled hospitals across the country.
- It will be an entitlement based scheme with entitlement decided on the basis of deprivation criteria in the SECC database. It will target about 10.74 crore poor, deprived rural families and identified occupational category of urban workers' families as per the latest Socio-Economic Caste Census (SECC) data covering both rural and urban.
- One of the core principles of Ayushman Bharat - National Health Protection Mission is to provide co-operative federalism and flexibility to states.
- For giving policy directions and fostering coordination between Centre and States, it is proposed to set up Ayushman Bharat National Health Protection Mission Council (AB-NHPMC) at apex level Chaired by Union Health and Family Welfare Minister. States would need to have State Health Agency (SHA) to implement the scheme.
- Covering almost all secondary and many tertiary hospitalizations (except a negative list).
2. Wellness centres
Rs 1200 crore ($170 million) allocated for 1.5 lakh (150,000) health and wellness centres. Under this 1.5 lakh centres will be setup to provide comprehensive health care, including for non-communicable diseases and maternal and child health services, apart from free essential drugs and diagnostic services. The government will upgrade existing Public Health Centres to Wellness Centres. The welfare scheme has been rolled out on August 15, 2018. Further, Contribution of private sector through CSR and philanthropic institutions in adopting these centres is also envisaged. The list of Services to be provided at Health & Wellness Centre include:
- Pregnancy care and maternal health services
- Neonatal and infant health services
- Child health
- Chronic communicable diseases
- Non-communicable diseases
- Management of mental illness
- Dental care
- Geriatric care emergency medicine
26 states and union territories accepted the scheme except four states: Delhi, Odisha, West Bengal and Telangana. More than a lakh (100,000) people have taken benefit of the scheme till October 2018. By 26th November more than 825,000 e-cards had been generated and there was a push to recruit more private hospitals to the scheme. Three had already been signed up: Cygnus Sonia Hospital in Nangloi, Dr. Shroff’s Charity Eye Hospital and Cygnus MLS Super-Speciality Hospital.
There have been media reports of widespread misuse of the Ayushman Bharat scheme by unscrupulous 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. There are at least 697 fake cases in Uttarakhand State alone, where fine of Rs one crore has been imposed on hospitals for frauds under the Scheme. However, unlike the earlier RSBY (Rashtriya Swasthya Bima Yojana) era, plagued by lax monitoring of insurance fraud, AB-PMJAY involves a robust information technology infrastructure overseeing transactions and locating suspicious surges across the country. Many hospitals have been blacklisted and the constantly evolving fraud-control system will play a major role in streamlining the scheme as it matures. Initial analysis of high-value claims under PMJAY 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 AB-PMJAY.
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