Ayushman Bharat-Know all about your Healthcare System

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Medically Reviewed by Dr. Aman Priya Khanna
Written by Sangeeta Sharma, last updated on 17 February 2023
Ayushman Bharat-Know all about your Healthcare System

A breakthrough towards Universal Health Coverage in India 

The health of a country is not only a reflection of its citizens' well-being but also economic progress. A healthy populace is more productive and contributes more efficiently to the country's overall progress. It necessitates universal healthcare coverage for all citizens.

The Indian healthcare system is currently at a crossroads, where it must address significant healthcare challenges and move closer to achieving Universal Health Coverage (UHC). Due to limited access to healthcare, insufficient workforce, sub-optimal quality of health services, and excessive out-of-pocket (OOP) cost, the country's present healthcare system is burdened. Every year, almost 50 million people in India are pushed below the poverty line due to healthcare costs. To tackle such a burden, simply providing services is insufficient. As a result, the present health system requires a mechanism for providing patients with holistic quality treatment that can solve critical healthcare gaps, provide comprehensive healthcare coverage, and increase patient access to healthcare.

AB is a significant step forward in realising the concept of 'health for everyone.' Ayushman Bharat's design provides complete coverage across all healthcare delivery verticals, including primary, secondary, and tertiary care. Its goal is to create a system that can offer a full spectrum of preventative, promotional, curative, diagnostic, rehabilitative, and palliative care services.

 

The World’s Largest Government Health Initiative- Ayushman Bharat

The Union Budget 2018-19 promised 'Ayushman Bharat' for a healthier India, as envisioned under NHP 2017. As part of Ayushman Bharat, the Indian government launched two significant health-related programmes to provide ground-breaking interventions in primary, secondary, and tertiary care systems, covering preventive and health promotion. 

According to the Indian government, these initiatives would ensure increased productivity and wellbeing, prevent pay loss and financial hardship, create jobs, and boost the healthcare industry. With this, India's healthcare system is ready to take a giant step toward Universal Health Coverage. AB-PMJAY, private insurance, and other government-funded health programmes such as CGHS, ESIS, Railways, and ECHS are expected to cover roughly 20 crores (80 per cent) of families.

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Initiative by PMJAY

1. Ayushman Bharat – Health and wellness centres (HWCs)

The first pillar of Ayushman Bharat is "Health and Wellness Centres," which will see 1.5 lakh existing Sub Health Centres (SHCs) and Primary Health Centres (PHCs) refurbished to provide Comprehensive Primary Healthcare (CPHC). It is open to all users and free of charge, focusing on wellness and delivering a broader range of services near home.

HWCs as a backbone for service delivery for AB-PMJAY and other government schemes:

  1. The IT integration between both pillars of Ayushman Bharat will allow ground-level workers to conduct follow-up visits on beneficiaries treated in higher referral facilities.
  2. To achieve fair population coverage and address issues of marginalisation, frontline workers would build population-based household lists and register all individuals (referred to as empanelment) and families residing within an HWC's catchment area.

The following are the main components of health and wellness centres: 

  1. The range of services available at HWCs
  2. HWCs' human resources
  3. HWCs' drugs and supplies
  4. HWC diagnostic services
  5. Infrastructure (physical)
  6. System of information and communication technology (ICT)
  7. Continuum of Care

The following is a list of the enhanced services that will be provided at HWCs: 

  1. Communicable illness management, including National Health Programs
  2. Outpatient care for mild diseases and acute uncomplicated illnesses
  3. NCD screening, prevention, treatment, and management
  4. Treatment of common ophthalmic and ENT issues
  5. Oral hygiene basics
  6. Services for the elderly and palliative care
  7. Medical assistance in an emergency
  8. Mental health screening and management at a basic level

2. Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY)

The second pillar of Ayushman Bharat, AB-PMJAY, was introduced on September 23, 2018. The scheme seeks to cover over ten crore poor and vulnerable families (about 50 crore beneficiaries) with secondary and tertiary care hospitalisation coverage of up to INR 5 lakh per family per year. The AB-PMJAY has taken over centrally funded initiatives, including the Rashtriya Swasthya Bima Yojana (RSBY) and the Senior Citizen Health Insurance Scheme (SCHIS). The AB-focus PMJAY on providing comprehensive secondary and tertiary healthcare services was further substantiated in the budget announcement on July 5 2019.

The plan aims to cut down on catastrophic costs by improving the public healthcare system and using the high-quality services of private healthcare providers at all levels of care. 

  1. AB-PMJAY is an entitlement-based programme that does not require formal enrolment.
  2. Out of the targeted families, AB- PMJAY was expected to cover roughly 10.74 per cent. Rural families account for 8.20 crore, whereas urban families account for 2.33 crore. 
  3. The AB-PMJAY scheme provides coverage up to INR5 lakh per family for secondary and tertiary care hospitalisation after the end of the year (the debut date the scheme is in a state), with no carry-over of the previous year's amount.
  4. There are no age or family size restrictions. 
  5. Treatment for procedures is covered.
  6. The coverage amount is supplied annually by the empanelled public and private healthcare floater providers in secondary and tertiary care.
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Conclusion

Ayushman Bharat's current progress necessitates significant push support to achieve the initiative's goals and provide 'Health for All.' It includes recommendations for building synergistic ties between the government and the business sector in key functional sectors so that Ayushman Bharat can be implemented effectively. However, overarching proposals must be made to improve the benefits and implement a long-term strategy to realise the vision.

Keep an eye out for additional information on the Ayushman Bharat Yojana at www.hexahealth.com. Alternatively, you can speak with a HexaHealth expert about your questions and concerns. 

Frequently Asked Questions on the Healthcare System

Q. Is there a cap on the number of children PMJAY can have?
A. Family size and member ages are not limited.

Q. What extra assistance is available to beneficiaries in the event of a complaint?
A. A beneficiary can always call the toll-free number 18001027480 at any time, seven days a week, with any questions or complaints. Mail can also be sent to grievance.snc@gmail.com in addition.

Q. Does PMJAY provide coverage for pre-existing conditions?
A. Yes, all pre-existing conditions are covered under the Scheme, and hospitals that have been granted an endorsement cannot refuse to treat beneficiaries.

Q. What would happen if a beneficiary family's overall treatment costs exceed Rs. 5 lakhs at any point in time or if the allocated amount of Rs. 5 lakhs is used up before a year?
A. If the beneficiary is Atal Amrit Abhiyan Scheme (AAA) eligible and the procedure is determined to be covered by the Scheme, an extra sum of 2 lakhs per person will be transferred. If not, the Beneficiary must pay an additional sum.

Q. What is the Pradhan Mantri Jan Arogya Yojana’s purpose?
A. The goal of PMJAY is to lessen the financial burden placed on underprivileged and vulnerable groups as a result of catastrophic hospital episodes and to guarantee their access to high-quality medical care.

Updated on : 17 February 2023

Reviewer

Dr. Aman Priya Khanna

Dr. Aman Priya Khanna

MBBS, DNB General Surgery, Fellowship in Minimal Access Surgery, FIAGES

12 Years Experience

Dr Aman Priya Khanna is a well-known General Surgeon, Proctologist and Bariatric Surgeon currently associated with HealthFort Clinic, Health First Multispecialty Clinic in Delhi. He has 12 years of experience in General Surgery and worke...View More

Author

Sangeeta Sharma

Sangeeta Sharma

BSc. Biochemistry I MSc. Biochemistry (Oxford College Bangalore)

6 Years Experience

She has extensive experience in content and regulatory writing with reputed organisations like Sun Pharmaceuticals and Innodata. Skilled in SEO and passionate about creating informative and engaging medical conten...View More

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