Prime Minister Narendra Modi announced the launch of the Prime Minister Jan Arogya Abhiyan (Ayushman Bharat Scheme) from Red Fort on the occasion of Independence Day.
It will be implemented across the country on the occasion of Deendayal Upadhyay Jayanti on 25 September.
Under this, about 10 crore poor families will be given health insurance of Rs 5 lakh per family annually.
The Modi government has allocated Rs 10,000 crore for this ambitious scheme.
It is being advertised as the world’s largest government healthcare insurance program.
Under this scheme, poor people will get free treatment facilities, no person has difficulty in getting this facility and hence the role of technology in it is important.
During the last ten years, the cost of hospitalization of patients in India has increased by almost 300 percent.
Ayushman Bharat Scheme Essay:
The Ministry of Labor and Employment launched the National Health Insurance Scheme (RSBY) in 2008.
It provides for cashless health insurance with benefit coverage of Rs 30,000 per year for families with five members living below the poverty line and 11 other distinct categories of unorganized workers.
The scheme was transferred to the Ministry of Health and Family Welfare from 1 April 2015 to integrate it with the health system and form part of the Government of India’s Comprehensive Health Facility Vision.
During 2016-17, 3.63 crore families in 278 districts of the country were covered under RSBY and these families are availing treatment facilities in 8,697 hospitals included in the panel list.
The Pradhan Mantri National Health Protection Scheme (NHPS) has been brought in keeping with the fact that various Central Ministries and Governments of the States / UTs have implemented Health Insurance / Safety Schemes for their beneficiaries.
There is a critical need to consolidate these schemes so that the goal of proper competence, accessibility and coverage is achieved.
Scope of Ayushman Bharat Scheme:
More than 50 to 55 crore people will come under this scheme. If the size of 55 crores is realized, then it will be equal to the third largest country in the world after India and China.
America has a population of 32 million. The Prime Minister has said that if Canada, Mexico and European countries are merged, then this population will be equal to 500 million.
It will provide security to 50 crore people (100 million families) with the burden of health expenses.
This program repeats the government’s commitment to help the poorest people of the country, it will benefit 40 percent of the country’s population.
The scheme will cover the secondary and tertiary levels of hospitalization.
There will be no limit on family size and age in this scheme with a coverage of five lakh rupees.
This scheme will help poor and weak families at the time of charge to the hospital for treatment.
Based on the socio-economic-caste census data, the poor and helpless population of the society will get financial help from the Ayushman Bharat NHPM scheme.
The Central Government sponsored ‘National Health Insurance Scheme’ (RSBY) and Senior Citizens Health Insurance Scheme (SCHIS) will be included in NHPM.
It will be the world’s largest health insurance scheme funded by the government, people will be able to get treatment in government and notified private hospitals.
All government hospitals are included in this scheme, also online list of private hospitals is being made.
Cashless, seamless and paperless technology has been developed under this scheme, health facilities will be provided to all eligible beneficiaries under the scheme.
This scheme mainly focuses on serious diseases, which are called secondary and tertiary hospitalization in medical language.
This scheme is for hospitalized care, OPD is not included in it, e.g., the patient must be admitted to the hospital, it will be accepted by both the Center and the state government.
To ensure that no person (women, children and elderly persons) is exempted, the scheme will not have any limit on the size and age of the family.
Eligibility of 10 crore families:
Ayushman Bharat Scheme -NHPM will be an eligibility based scheme and eligibility will be decided on the basis of deficiency standard in SECC data base.
A very transparent process has been adopted for selecting the beneficiaries of this scheme.
Different categories in rural areas include families that have a room with an earthen wall and earthen ceiling.
- Families that do not have any adult members between the ages of 16 and 59 years.
- Families whose head is female in which there is no adult member between 16 and 59 years of age.
- A family that has a disabled member and no physically competent adult member.
SC / ST families- Ayushman Bharat Scheme Essay:
- Landless families earning large share of income from human casual wages.
- Families have been included automatically in rural areas with no roof to live, living on bond, hunting families, primitive tribe groups, and legally freed bonded laborers.
- Beneficiaries will be able to benefit from both empaneled government and private hospitals.
- For this, the beneficiary eligibility system (beneficiary card) has been developed which is based on technology.
The list of all eligible beneficiaries will soon be made available on a official website.
All the eligibility details will be available at all 3 lakh common service centers operating across the country.
For this, a helpline number 1475 has been prepared, where you will get information about your eligibility by calling.
Hospitals covered under the Ayushman Bharat Scheme:
All government hospitals in the states implementing AB-NHPM will be deemed to be empaneled for the scheme.
Hospitals affiliated to Employees State Insurance Corporation (ESIC) can also be included in the panel on the basis of bed admission ratio standard.
Private hospitals will be connected in an online manner based on defined standards.
Package (treatment) and package rate:
To control the cost, treatment will be paid based on the treatment package rate (defined in advance by the government).
The package rate will include all costs related to treatment, this will be a cashless, paperless transaction for the beneficiaries.
States will have the flexibility to modify these rates to a limited extent keeping in mind the requirements of the state.
1350 packages have been approved under the scheme, 250 packages (most) have been approved for general surgery.
According to a study by NITI Aayog, the poor family spends the most on it is the General Surgery Procedure, this is the reason why general surgery is given more importance.
For Cancer surgery 112 packages have been approved under better treatment i.e. Oncology (which is a facility).
Different packages have been approved for cervix or breast cancer, tumors, child leukemia.
Urology and orthopedic are placed on the third and fourth numbers.
Under this ayushman bharat scheme, the highest package rate has been kept for bone tumors, which is 2.50 lakh rupees.
Role of the states- Ayushman Bharat Scheme Essay:
This scheme is a better model of cooperative federalism, there is participation of both the Center and the state.
Its average is 60:40, while in the north-eastern and hilly states like Jammu and Kashmir, Himachal Pradesh and Uttarakhand, the center-state share will be 90:10.
States will have full participation in the implementation of this scheme and all states will have to implement this scheme.
This would allow the extension of the scheme to both State Governments, both transversely and vertically, to ensure proper integration with the various health schemes of the existing Health Insurance / Central Ministries / Departments and the State Governments (at their own cost).
States will be free to choose the modalities for implementing the scheme.
States will be able to implement the scheme through an insurance company or directly through a trust / society or in a mixed form.
The States will need a State Health Agency (SHA) to implement the scheme.
States will have the option of using the existing Trust / Society / Non-Profit Company / State Nodal Agency as SHA or to create a new Trust / Society / Non-Profit Company / State Health Agency to implement the scheme.
In partnership with NITI Aayog, a robust, standard, ascending and interoperability IT platform will be launched which will have paperless and cashless transactions.
This will help identify potential fraud / prevent fraud and abuse, it will have a well-defined grievance redressed system.
In addition, the right to pre-treatment with moral hazards (possibility of misuse) has been made mandatory.
To ensure that the scheme reaches the desired beneficiaries and other stakeholders, a comprehensive media and outreach strategy has been developed.
It includes, print media, electronic media, social media platforms, traditional media, IEC materials and outdoor activities. Are included.
Ayushman Bharat National Health Protection Mission Council:
It is proposed to set up Ayushman Bharat National Health Protection Mission Council (AB-NHPMC) under the chairmanship of Union Minister of Health and Family Welfare at the top level to give policy directions and speed up coordination between the Center and the States.
It will be chaired jointly by Secretary (Health and Family Welfare) and Member (Health), NITI Aayog.
The Financial Adviser, Ministry of Health and Family Welfare, Ministry of Health, Additional Secretary and Mission Director, Ayushman will be the Member Secretary, CEO of National Health Protection Mission of India.
As per the requirement, the Health Secretary of the states can also be its member.
It is proposed to set up Ayushman Bharat National Health Protection Mission Agency (AB-NHPMA) as a society to manage the scheme at the operational level.
AB-NHPMA will be headed by a full-time CEO who will be of the level of Secretary / Additional Secretary to the Government of India.
Challenges in the implementation of the Ayushman Bharat Scheme:
The biggest challenge for Ayushman Bharat Scheme stated in this essay, is that private hospitals do not agree on the rates fixed by the government for the treatment of various diseases.
The government has fixed the rates on the basis of estimates on which private hospitals are not ready to treat.
The government says that private hospitals should treat these rates for one year, after studying it after one year, these rates will be revised.
These rates should be fixed by the government in a technical way, otherwise this scheme will die like other schemes.
Lack of healthcare facility:
At the same time, the population has doubled to seven times, at which speed hospitals have not doubled.
According to an estimate, there are around 60,000 – 70,000 hospitals in the country including both big and small, of which 60 percent have 30 or less beds.
According to a 2014 report by NSS, 1/3 of the beds in government and private hospitals across the country remain empty.
They can be put to proper use and can be used for the scheme at a nominal cost.
All hospitals will have to decide the number of beds for Ayushman Bharat. If this is not done then the implementation of this ambitious plan will be a big challenge.
In India, health services are spent equal to 1 percent of GDP, which is targeted to be increased to 2.5 percent.
Due to the Ayushman Bharat Scheme, there will be a huge demand in the country, in such a situation, there will be a challenge to strengthen the primary health centers with the expansion of private hospitals.
The huge difference in the availability and demand of doctors, nurses and para medical staff to treat such a large population is also a big challenge.
Conclusion for Ayushman Bharat Scheme Essay:
This Ayushman Bharat Scheme is not only for the Government of India or the State Governments.
The biggest role of the common citizen, is that of all hospitals, doctors, nurses and para medical staff, with whose support the poor people will get their rights.
Public medical facilities in the country are not considered very well and many negative aspects such as lack of accountability are exposed.
Also, it is still a dream for all the countrymen to have access to good hospitals.
Obviously, while a strategy is being chalked out to achieve many goals under this Ayushman Bharat Scheme mentioned in this essay, there are many aspects which need more attention.
The pressure of patients on government hospitals is high. In such a situation, private hospitals will have to participate extensively.
The government needs to work on health infrastructure by increasing the budget of the health sector.
The beneficiaries can get the benefit of this scheme only when the first aid centers are strong and the government ensures the participation of all the parties.