AFPA

Ayushman Bharat Yojana – Features, Implementation, Challenges

“The programme will lay stress on affordable and preventive healthcare.”

Ayushman Bharat Pradhan Mantri Jan Arogya Yojana aims to provide free access to healthcare for 50 crore people in the country. People using the program access their own primary care services from a family doctor. When anyone needs additional care, then PM-JAY provides free secondary health care for those needing specialist treatment and tertiary health care for those requiring hospitalization.

The programme is part of the Indian government’s National Health Policy and is means-tested. It was launched in September 2018 by the Ministry of Health and Family Welfare who established the National Health Authority as an organization to administer the program. It is a centrally sponsored scheme and is jointly funded by both the federal government and the states. By offering services to 50 crore (500 million) people it is the world’s largest government sponsored healthcare program.

In 2017 an Indian version of the GLOBAL BURDEN OF DISEASE STUDY reported major diseases and risk factors from 1990 to 2016 for every state in India. This study identified major health challenges which the government could address. The Indian government first announced the Ayushman Bharat Yojana as a universal health care plan in February 2018 in the 2018 Union budget of India.

In June 2018 the applications opened for hospitals through an “empanelment process”. In July 2018, the Ayushman Bharat Yojana recommended that people access benefits through Aadhaar, but also said that there was a process for people to access without that identity card. Ayushman Bharat Pradhan Mantri Jan Arogya Yojana AB PM-JAY was first launched on 23 September 2018 at Ranchi, Jharkhand. By 26 December 2020 the scheme was extended to the Union Territories of Jammu, Kashmir and Ladakh.

 

Features

(a) Providing health coverage for 10 crores households or 50 crores Indians.

(b) Providing a cover of ₹5 lakh (US$7,000) per family per year for medical treatment in empaneled hospitals, both public and private.

(c) Offering cashless payment and paperless recordkeeping through the hospital or doctor’s office.

(d) Using criteria from the Socio Economic and Caste Census 2011 to determine eligibility for benefits.

(e) No restriction on family size, age or gender; all previous medical conditions are covered under the scheme.

(f) It covers 3 days of pre-hospitalisation and 15 days of post-hospitalisation, including diagnostic care and expenses on medicines.

(g) The scheme is portable and a beneficiary can avail medical treatment at any PM-JAY empanelled hospital outside their state and anywhere in the country

(h) Providing access to free COVID-19 testing.

Implementation

(a) India’s 28 states and 8 union territories each make their own choice about whether to participate in Ayushman Bharat Yojana.

(b) In February 2018 when the program was announced 20 states committed to join.

(c) In September 2018 shortly after launch some states and territories declined to participate in the program.

(d) Maharashtra and Tamil Nadu initially declined to join because they each had their own state healthcare programmes. Those programs, Mahatma Jyotiba Phule Jan Arogya Yojana and the programme for Tamil Nadu, were already functioning well.

(e) These states later both joined Ayushman Bharat Yojana with special exceptions to make it part of their existing infrastructure.

(f) In a similar way, Kerala, despite having its own health program agreed to begin using Ayushman Bharat Yogana from November 2019.

(g) West Bengal initially joined the program but then opted out in favor of establishing their own regional health programme.

(h) Telangana did the same.

(j) By January 2020 Odisha had not joined the scheme.

(l) In March 2020 Delhi announced that it would join the program.

 

Participation by local people

In May 2020 Prime Minister Narendra Modi said in his radio show Mann Ki Baat that the Ayushman Bharat scheme had recently benefited more than one crore people.

By May 2020, the scheme had provided more than 1 crore treatments with a value of ₹13,412 crore.

The number of public and private hospitals empanelled nationwide stands at 24,432. The Ayushman Bharat Yojana programme announced a special collaboration with the Employees’ State Insurance programme in November 2019.

From June 2020, the program had entered a pilot to cover 120,000 workers with that insurance at 15 hospitals.

 

Challenges

(a) A major challenge of implementing a national health care scheme would be starting with infrastructure in need of development to be part of a modern national system.

(b) India still has some basic healthcare challenges including relatively few doctors, more cases of infectious disease, and a national budget with a comparatively low central government investment in health care.

(c) Some of the problems lay outside the Health Ministry such as urban development or transport.

(d) While many government hospitals have joined the program, many private corporate hospitals have not. The private hospitals report that they would be unable to offer their special services at the government low price, even with a government subsidy.

(e) The scheme has faced challenges in form of fraudulent bills. In response, National Health Authority has revoked empanelment of 171 hospitals and imposed a penalty of ₹4.6 crore (US$640,000). Another 390 hospitals have been issued show cause notice.

(f) There have been media reports of misuse of the Ayushman Bharat scheme by unscrupulous private hospitals through submission of fake medical bills. AB-PMJAY involves a robust information technology infrastructure overseeing transactions and locating suspicious surges across the country.

(g) Health Minister Harsh Vardhan has blacklisted hospitals and named them publicly for misconduct.