Ayushman Bharat yojana
Why in the News?
Recently, Comptroller and Auditor General of India (CAG) presented report on Performance Audit of AB-PMJAY.
Ayushman Bharat yojana Quick Facts
Purpose: To achieve the vision of Universal Health Coverage (UHC)
Type: Centrally Sponsored Scheme
Target: 12 crore families (initially it was only 10.74 crore)
Components: Health and Wellness Centres (HWCs); Pradhan Mantri Jan Arogya Yojana (PM-JAY)
Objectives
Holistically address the healthcare system (covering prevention, promotion and ambulatory care) at the primary, secondary and tertiary level.
To reduce the financial burden on poor and vulnerable groups arising out of catastrophic hospital episodes and ensure their access to quality health services.
Ayushman Bharat eligibility
Rural Eligibility (Based on Deprivation Indicators)
Urban Eligibility (Based on Occupation)
Senior Citizens (Aged 70+) — Universal Expansion.
Salient Features :
Background:
Recommended by the National Health Policy 2017
Benefits:
Refer to the Infographic in the end
Health and Wellness Centre:
1,50,000 Health & Wellness Centres (HWCs) will be created to deliver Comprehensive Primary Health Care (CPHC), that is universal and free to users.
Focus: Wellness and the delivery of an expanded range of services closer to the community
Funding: Through National Health Mission (NHM)
Pradhan Mantri Jan Arogya Yojana (PM-JAY)
Background:
The erstwhile National Health Protection Scheme (NHPS) has been rechristened as PM-JAY. It is the largest health assurance scheme in the world.
Beneficiaries:
Identified through Socio-Economic Caste Census-2011 (SECC-2011).
Also, families that were covered under Rastriya Swasthya Bima Yojana (RSBY) but did not form part of the SECC-2011.
3 modes of implementation:
Insurance:
SHA pays premium to the insurance company per eligible family for the policy period.
Assurance/Trust:
SHA directly reimburse the healthcare providers
Mix:
Mix of above two.
Implementing Agencies:
National Health Authority (NHA)
an autonomous body chaired by the Union Minister of Health & Family Welfare.
State:
SHA headed by CEO appointed by the state government.
District:
District Implementing Unit (DIU) chaired by DC/DM/Collector of the district.
Transparency and accountability:
4 modes of verification
of beneficiaries-Aadhar based e-KYC, Finger print, iris scan, and face authentication.
Whistle Blower
Policy issued by the NHA.
Anti-Fraud Cell
in the state for carrying out surprise inspections, imposing penalties, de-empanelment, etc.
PM-JAY benefits :
Financial Cover & Scale
Cashless and Paperless Access
Comprehensive Coverage of Medical Expenses
No Pre-existing Condition Barriers
Standardized Medical Packages
Key initiatives:
Ayushman Bhava campaign:
To extend comprehensive healthcare coverage to every village and town, transcending geographical barriers and ensuring that no one is left behind.It aims to saturate coverage of health services through its three components:
(1) Ayushman – Apke Dwar 3.0,
(2) Ayushman Melas at Health and Wellness Centres (HWCs) and Community Health Centres (CHCs) and
(3) Ayushman Sabhas in every village and panchayat
