Ayushman Bharat Mission: PMJAY Scheme Features and Benefits

The Indian government started the Ayushman Bharat Scheme in 2018 as a nationwide health protection program. It is a flagship program that deals with primary, secondary, and tertiary health issues. It attempts to fill in the gaps left by earlier programs like the Rashtriya Swasthya Bima Yojana, as recommended by the National Health Policy of 2017. Previous programs neglected primary healthcare in favor of secondary and tertiary care. The Ayushman Bharat Scheme was launched to address this, focusing on health issues at all three levels.

Ayushman Bharat Mission

The Indian Central Government’s health program is known as the Ayushman Bharat Scheme. Launched to leave no one behind, the initiative aims to fulfill the Sustainable Development Goals (SDGs) and Universal Health Coverage (UHC). All three levels of healthcare—primary, secondary, and tertiary—are covered by this program. It includes promotion, illness prevention, and all stages of ambulatory care. The Pradhan Mantri Jan Arogya Yojana and Health and Wellness Centers are two of the program initiatives.

Need of Ayushman Bharat Scheme

• Despite being one of the world’s fastest-growing economies, the World Bank still classified India as a Lower Middle-Income Country (LMIC). The socioeconomic and health sectors’ inconsistencies are the primary cause of this.
• Healthcare providers, especially public sector hospitals, face numerous challenges, including inadequate funding, a scarcity of medications and medical supplies, and a dearth of medical personnel with the necessary training.
• Furthermore, the data shows that throughout the previous 20 years, only 1.2% of India’s GDP was allocated to the health sector. Of that, 21 percent came from government funding, with the remaining amount coming from personal expenses.
• Primary health care was not addressed by the majority of the federal and state government initiatives and programs.
• According to the National Sample Survey Office’s 71st round social consumption and health survey report, 86% of households in rural areas and 82% of households in urban areas, respectively, do not have access to health insurance. As a result, the majority of families incur debt to pay for the serious medical issues that arise.
• In 2018, the Indian government launched the National Health Protection Mission, also known as the Ayushman Bharat Programme, to address all of these issues and difficulties.

Ayushman Bharat Program Initiatives

1. Health and Wellness Centers (HWCs)
   The current network of primary health centers and sub-centers is upgraded to Health and Wellness Centers (HWCs) under the Ayushman Bharat Scheme scheme. The Indian government unveiled this plan’s component in February 2018. Approximately 1,50,000 HWCs are expected to be built across the nation in the upcoming years. These centers provide Comprehensive Primary Health Care (CPHC), which addresses non-communicable diseases and mother and child health services.
2. Pradhan Mantri Jan Arogya Yojana
   The second part of the Ayushman Bharat Scheme was introduced on September 23, 2018, by the Honorable Prime Minister of India, Shri Narendra Modi. It is known as the Pradhan Mantri Jan Arogya Yojana (PM-JAY). The government wants to implement demand-driven changes in the healthcare industry to help vulnerable families with their urgent hospital requirements and shield them from disastrous financial shocks. While several health insurance programs are in place in different states, most are exclusive to certain states and run separately. States used different databases to determine who was eligible for these kinds of programs.

Ayushman Bharat Scheme Highlights
Topic	Description
Scheme Name	Ayushman Bharat Scheme
Objective	To offer needy individuals and families in India financial security as well as health coverage
Coverage	More than 50 crore recipients (about 10 crore households)
Ayushman Bharat Health Insurance Coverage Limit	₹5 lakh annually for each household
Target Population	Families with low socioeconomic status determined by the Socio-Economic Caste Census (SECC)
Key Features	The implementation of universal health coverage, cashless treatment, nationwide benefit portability, pre-authorization, coverage for pre-existing conditions, coverage for secondary and tertiary care, day care procedures, and follow-up care are all desirable outcomes.
Services covered	Hospitalization, operations, tests, medications, aftercare, and more services
Implementation Status	Enrolling and successfully identifying beneficiaries, creating hospitals with an affiliation, putting in place procedures for payments and claims, and extending the network indefinitely

Ayushman Bharat Digital Mission (ABDM)

The primary goal of this mission is to equip the Indian healthcare sector with digital infrastructure. It seeks to close the gap between various healthcare providers by establishing a safe network for the exchange of medical information. The ABHA app is also a part of this objective. It enables users to electronically manage their medical records and generate a personalized health ID. ABDM development is ongoing. People can already download and register for their Ayushman Bharat Health Account (ABHA) using the ABHA app.

Ayushman Bharat Benefits

The benefit coverage offered by India’s government-funded health insurance systems has been divided into several states, with yearly coverage ranging from INR 30,000 to INR 3,00,000 per family. PM-JAY offers cashless coverage for specified secondary and tertiary care conditions up to INR5,00,000 per year to all eligible families. All of the costs associated with the following therapy components are covered by the program. Some more benefits are listed below.

• Medical examination, care, and advice
• Drugs and supplies for medical use
• Services for both non-intensive and intense care
• Lab and diagnostic examinations
• Medical implantation services
• Benefits of accommodations
• Proper meal services
• Problems that develop during therapy Follow-up care after hospitalization for a maximum of fifteen days

One or more family members may access the INR 5,00,000 benefits since they are provided on a family floater basis. A family could only have five members in the RSBY. Nevertheless, PM-JAY has been created such that there is no upper limit on the number of family members or their ages, based on the lessons learned from earlier programs. Furthermore, coverage for pre-existing conditions begins on the first day. This implies that at the moment of enrollment, any qualified individual with a medical condition that was not previously covered by PM-JAY will also be able to receive treatment for that disease.

Ayushman Bharat Features

In Ayushman Bharat Mission focuses on the largest programs for health insurance and assurance worldwide, this PM-JAY scheme is funded by the government. Various Features of the scheme are listed below:

• It offers coverage for secondary and tertiary care hospitalization in both public and private institutions in India up to Rs. 5 lakhs per family annually.
  These benefits are available to around 12 crore impoverished and vulnerable families, or over 55 crore beneficiaries.
• At the point of service, which is the hospital, PM-JAY gives the beneficiary cashless access to medical services.
• The goal of PM-JAY is to lessen the staggering medical costs that force around 6 crore Indians into poverty every year.
• It pays for up to three days of pre-hospitalization and fifteen days of post-hospitalization costs, including medications and diagnostics.
• The size, age, or gender of the family is not restricted.
• From the beginning, all pre-existing conditions are covered.
• The program’s benefits are transferable throughout the nation, so a recipient can receive cashless care at any public or private hospital in India that has been accredited.
• Approximately 1,929 procedures are included in the services, which cover all treatment-related expenses such as medication, supplies, diagnostic tests, doctor’s fees, lodging costs, surgeon’s fees, OT and ICU fees, etc.
• For medical services rendered, public hospitals receive payment on par with private hospitals.

Ayushman Bharat Health Card Features

1. Health Coverage: Every household with an Ayushman Card is eligible for up to Rs 5 lakh in annual health coverage. It provides coverage for a broad range of medical costs, including hospital stays, operations, diagnostics, and treatments.
2. Cashless Treatment: Any hospital in India that is designated by the government may accept patients with Ayushman Cards without charging a fee. The hospital does not require you to send them any money. It provides easy access to all medical services. Just keep in mind that not all hospitals are eligible for it. First, look into the local hospital that is designated by the government.
3. Family Benefits: The Ayushman Card offers benefits to families. As to the Socio-Economic Caste Census (SECC) Database, this scheme provides coverage for every member of a family.
4. Portability: The Ayushman Card can be used in all Indian states and union territories. If you move around, you can still receive your free therapy.
5. No Age Bar: There isn’t an age cap. Everyone, young and old, is eligible for free medical care under the Ayushman Card.

Ayushman Bharat Health Scheme Drawbacks

• It is still difficult to make sure that all qualified recipients are aware of the program and can benefit from it. In rural places, there’s a chance that many eligible people are unaware of the program.
• The capability and accessibility of the healthcare system are critical to the program’s success. The lack of medical facilities and qualified medical personnel in some areas makes it difficult to provide services.
• It is essential to make sure that a large network of hospitals that are impaneled provides high-quality healthcare services. Effective treatment for beneficiaries and the prevention of fraud are both dependent on quality control measures.

The Way Ahead

The actions listed below can be implemented to increase the Ayushman Bharat Scheme’s efficacy and impact:

1. Stepping up awareness activities and reaching out to rural locations with a variety of communication platforms. By doing this, you can make sure that everyone who qualifies for the program knows about it.
2. Access to high-quality healthcare services would be enhanced by ongoing investments in healthcare infrastructure, especially in underprivileged communities.
3. Ensuring beneficiary satisfaction and improving the overall quality of healthcare services are two benefits of strengthening quality assurance methods. Strong mechanisms for accreditation, assessment, and monitoring are part of this.
4. Close cooperation with governmental agencies and medical providers will promote efficient execution and take care of regional issues. Additionally, it will encourage accountability and ownership at the local level.
5. Process simplification through the use of digital platforms will improve service delivery and make the scheme’s implementation go more smoothly.