Syllabus: GS2 – Governance, Government Policies and Interventions, Issues Relating to Development and Management of Social Sector/Services relating to Health
Context
The Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) has successfully completed five years.
Content
Ayushman Bharat
- Ayushman Bharat, a flagship scheme of Government of India, was launched to achieve the vision of Universal Health Coverage (UHC).
- This initiative has been designed to meet Sustainable Development Goals (SDGs).
- Ayushman Bharat is an attempt towards a comprehensive need-based health care service.
- It aims to undertake path breaking interventions to holistically address the healthcare system at the primary, secondary and tertiary level.
- Ayushman Bharat comprises two interrelated components, which are Health and Wellness Centres (HWCs) and Pradhan Mantri Jan Arogya Yojana (PM-JAY)
Health and Wellness Centers (HWCs)
- They are to deliver Comprehensive Primary Health Care (CPHC) bringing healthcare closer to the homes of people.
- They cover both, maternal and child health services and non-communicable diseases, including free essential drugs and diagnostic services.
Pradhan Mantri Jan Arogya Yojana (PM-JAY)
- It is the largest health assurance scheme in the world which aims at providing a health cover of Rs. 5 lakhs per family per year for secondary and tertiary care hospitalization to over 12 crores poor and vulnerable families that form the bottom 40% of the Indian population.
- The households included are based on the deprivation and occupational criteria of Socio-Economic Caste Census 2011 (SECC 2011) for rural and urban areas respectively.
- PradhanMantri Jan Arogya Yojana (AB-PMJAY) is a centrally sponsored scheme.
Benefits of PM-JAY
- PM-JAY provides cashless access to health care services for the beneficiary at the point of service, that is, the hospital.
- PM-JAY envisions to help mitigate catastrophic expenditure on medical treatment ( out-of-pocket expenditure) which pushes nearly 6 crore Indians into poverty each year.
- It covers up to 3 days of pre-hospitalization and 15 days post-hospitalization expenses such as diagnostics and medicines.
- Interstate portability (ie, a patient registered in one state is entitled to receive care in any other state that has an AB-PMJAY programme) has proved helpful to migrants, especially in emergencies.
- Public hospitals are reimbursed for the healthcare services at par with the private hospitals.
Challenges in the implementation of PM JAY
- Since Public Health is a state subject, it is critical to streamline and harmonize the existing State health insurance schemes to PMJAY. West Bengal, Odisha, and Delhi have not implemented PMJAY.
- Since PMJAY is the world’s largest government-funded health protection scheme, covering approximately 55 crore beneficiaries,Consolidating and stabilizing the implementation of the scheme is a massive undertaking.
- Lack of motivation for high-quality tertiary hospitals to participate in the scheme.
- Lack of awareness of beneficiaries regarding their eligibility and entitlements leading to underutilization of scheme in many states.
- Ensuring quality standards of hospitals providing healthcare services.
- Preventing and mitigating fraudulent practices.
- The participation of private healthcare providers in the Pradhan Mantri Jan Arogya Yojana scheme has not been optimal due to insufficient motivation or concerns about the financial viability of the scheme.
- Varied quality and infrastructure in public facilities
- Lack of trained manpower at ground level in many states
- Low Public spending on healthcare in India.ie, India spends just 1%-2% of gross domestic product (GDP).
Achievements of PMJAY
- The scheme has taken the country closer to Sustainable Development Goal 3.8, which envisions universal health coverage.
- Reduced out-of-pocket expenditure (OOPE) . ie,If the beneficiaries had availed the same care outside AB-PMJAY’s ambit, the total cost of treatment would have been nearly two times higher.
- Bridged the shortfall between healthcare providers and service-takers.
- So far, more than 24 crore Ayushman Cards (The Ayushman Card ,a pre-paid card worth Rs 5 lakh, which can be used to avail free treatment at hospitals)have been created.
- About 48 percent of treatments under the scheme have been availed by women.
- To elicit the participation of private service providers, health benefit packages (HBPs) covering all in-patient treatment have been revised five times in the last five years.
- Every hospital is mandated to have dedicated Pradhan Mantri Arogya Mitras (PMAMs) who guide the beneficiaries in accessing healthcare services.
- Service delivery is end-to-end digitized, obviating systemic bias. Apart from an internal monitoring system, NHA has deployed a public dashboard where the scheme’s implementation, on a day-to-day basis, can be tracked.
- The National Anti-Fraud Unit (NAFU) was launched inorder to design, implement and oversee anti-fraud initiatives.
- AB-PMJAY scheme added people from the transgender community to its list of beneficiaries thereby promising inclusivity.Packages were designed on Sex Reassignment Surgery (SRS).
Way forward
- Monitoring and Evaluation is key for successful implementation and ensuring the intended results of AB-PMJAY.
- Also, to realize the scheme’s full potential, the National Health Authority (NHA) along with its counterparts in the states should aim to provide every possible beneficiary with an Ayushman Card.
- Moreover,Regional disparities and infrastructural gaps should be properly addressed .
Related topics
Ayushman Bharat Health Infrastructure Mission (ABHIM)
- The PM-ABHIM is a Centrally Sponsored Scheme with some Central Sector Components, for implementation of the Atmanirbhar Bharat Package for the health sector .
- The objective of the scheme is to fill critical gaps in health infrastructure, surveillance and health research – spanning both the urban and rural areas so that the communities are Atmanirbhar in managing such pandemic/ health crises.
- It is the largest Pan-India scheme for public health infrastructure since 2005.
Ayushman Bharat Digital Mission(ABDM)
- The Ayushman Bharat Digital Mission (ABDM) aims to develop the backbone necessary to support the integrated digital health infrastructure of the country.
- It will bridge the existing gap amongst different stakeholders of the Healthcare ecosystem through digital highways.
- The implementation of Ayushman Bharat Digital Mission (ABDM) is expected to significantly improve the efficiency, effectiveness, and transparency of health service delivery overall.
Social Endeavor for Health and Telemedicine (SEHAT)
- Social Endeavor for Health and Telemedicine (SEHAT) is a telemedicine health initiative in India launched in 2015 .
- The main motive of this scheme was to offer telemedicine centers in rural areas of India.
- The people in rural areas can consult doctors online and also order generic drugs.
- Under the scheme ,Common Service Centers (CSC) were already being offered in many areas.
Sustainable Development Goal 3.8
- Target : To achieve universal health coverage, including financial risk protection, access to quality essential health-care services and access to safe, effective, quality and affordable essential medicines and vaccines for all.
Socio-Economic Caste Census (SECC) 2011
- The Ministry of Rural Development Government of India, commenced the Socio Economic and Caste Census (SECC) in 2011 through a comprehensive door to door enumeration across the country.
- This is the first time such a comprehensive exercise has been carried out for both rural and urban India.
- It is also expected to generate information on a large number of social and economic indicators relating to households across the country.
Ayushman Bharat PM-JAY Startup Grand Challenge
- Ayushman Bharat PMJAY Start-Up Grand Challenge is a call to action for the Indian start-up community to generate cutting-edge solutions for supporting the National Health Authority towards more effective implementation of Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) and empowering 500 million people to gain access to affordable healthcare.
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