|Demand of the question
Introduction. Contextual Introduction.
Body. Key features of Pradhan Mantri Jan Arogya Yojana (AB-PMJAY). How scheme would ensure health of Indian poor? Various challenges.
Conclusion. Way forward.
Ayushman Bharat – Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) is a Centrally Sponsored Scheme having central sector component under Ayushman Bharat Mission under the Ministry of Health and Family Welfare (MoHFW). PMJAY is a major national health reform to rapidly extend access to hospital care for 500 millionpoor and vulnerable people. It is touted as world’s largest healthcare scheme.
Key features of National Health Protection Mission (AB-PMJAY):
- AB-PMJAY provides a defined benefit cover of Rs. 5 lakh per family per year. This cover will take care of almost all secondary care and most of tertiary care procedures.
- To ensure that nobody is left out (especially women, children and elderly) there will be no cap on family size and age in the scheme.
- The benefit cover will also include pre and post-hospitalisation expenses. All pre-existing conditions will be covered from day one of the policy. A defined transport allowance per hospitalisation will also be paid to the beneficiary.
- 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/private empanelled hospitals across the country.
- The beneficiaries can avail benefits in both public and empanelled private facilities. All public hospitals in the States implementing AB-PMJAY, will be deemed empanelled for the Scheme.
- Hospitals belonging to Employee State Insurance Corporation (ESIC) may also be empanelled based on the bed occupancy ratio parameter. As for private hospitals, they will be empanelled online based on defined criteria.
- To control costs, the payments for treatment will be done on package rate (to be defined by the Government in advance) basis. The package rates will include all the costs associated with treatment.
- For beneficiaries, it will be a cashless, paper less transaction. Keeping in view the State specific requirements, States/ UTs will have the flexibility to modify these rates within a limited bandwidth.
How scheme would ensure health of Indian poor?
- The system will be cashless and largely paperless. This will prevent leakages and corruption in the scheme and would lead to targeted benefits.
- The poor and vulnerable stand to benefit from the scheme.Over 10.74 crore poor and vulnerable entitled families (approximately 50 crore beneficiaries) are eligible for these benefits.
- It will be an enabler of quality, affordability and accountability in the health system.Ayushman Bharat is expected to advance India’s pursuit of universal health coverage (UHC).
- This will ensure all people can access quality health services when and where they need them,without suffering financial hardship, which is also one of the WHO South-East Asia Region’s FlagshipPriorities.
- From the day PMJAY was launched, almost half of all eligible families are now covered for hospitalcare.
- Another impact of the PMJAY will be rationalisation of the cost of care in the private sector.The scheme will also create lakhs of jobs for professionals and non-professionals — especially women.
Concerns/Challenges related to the scheme:
- Major inequalities still remain.Millions of people across India are pushed into poverty because of out-of-pocket spending onhealth care, at least 4% of the population.
- Getting prices right, because costs for the same procedure are likely to differ across hospitalsbecause of quality, location and capacity.
- Massive shortages in the supply of services (human resources, hospitals and diagnostic centres inthe private/public sector).
- Monitoring and ensuring accountability because Rastriya swasthya bima yojana lacked thismechanism that led to its poor implementation.
- Infrastructure constraints to take on the additional patients from other States.
There is need for real-time monitoring of implementation. This will allow problems to be detected early on, thereby enhancing accountability, as well as facilitating course corrections where necessary.There is a commitment in the National Health Policy to raise the percentage of GDP allocated to health from 1.2% today to 2.5% by 2022. This must be backed up by effective and affordable hospital care.