Ayushman Bharat Diwas – 30 April

India celebrates Ayushman Bharat Diwas under Gram Swaraj Abhiyan on 30th April every year with an aim to provide free access to healthcare for 50 crore people, belonging to poor and vulnerable families.

It hopes in attaining the highest possible level of health and wellbeing for all at all ages, through a preventive and promotive health care orientation in all developmental policies and universal access to good quality healthcare services without anyone having to face financial hardship consequently.

Pradhan Mantri Jan Arogya Yojana

The day marks the launch of Pradhan Mantri Jan Arogya Yojana (PMJAY) or the National Health Protection Scheme (NHPM) on 30th April 2018. Ayushman Bharat (PMJAY) was launched as a step towards Universal Health Coverage (UHC). UHC entails ensuring all people have access to quality health services – including prevention, promotion, treatment, rehabilitation, and palliation – without incurring financial hardship. The concept covers three key elements — access, quality, and financial protection. India is committed to achieving Universal Health care for all by 2030, which is fundamental to achieving the other Sustainable Development Goals.

The PMJAY was a step in this direction providing insurance cover to the poorest 40 percent of the population. Over 50 crore Indians are covered under the scheme with an insurance cover of Rs 5 lakhs per family. PMJAY provides comprehensive hospitalization cover for secondary and tertiary care.

The financial implications of hospitalization can be devastating. PMJAY was conceptualized to provide financial protection against hospitalization to the most vulnerable parts of our society. The average hospitalization at Rs. 20,000 per episode is more than the annual consumer expenditure of nearly half our population. Further, delayed hospitalization can be debilitating and have long-lasting negative effects. PMJAY has averted these disastrous consequences for over 1.2 crore treatments under the scheme to date. Beyond providing much-needed cover, PMJAY also re-invigorated India’s health landscape by ushering in demand-side financing and laying the foundations of a modern IT platform for health.

PMJAY has scored over its predecessor – Rashtriya Swasthya Bima Yojana (RSBY) – on several measures. It covers a larger population, provides a more comprehensive benefits package, and has a wider hospital network for availing care. In terms of operations, it has superior IT and governance systems and is building state capacity in management and governance. Availability of portable benefits where eligible individuals can seek care anywhere in India is an example of this capacity.

Ayushman Bharat Yojana – National Health Protection Scheme

Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (PM-JAY) was launched in 2018 by Prime Minister Narendra Modi. The scheme will cover over 10 crore poor and vulnerable families (approximately 50 crore beneficiaries) providing coverage up to 5 lakh rupees per family per year for secondary and tertiary care hospitalization.

Salient Features of the scheme

Ayushman Bharat – National Health Protection Mission will have a defined benefit cover of Rs. 5 lakh per family per year.
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 impaneled hospitals across the country.
Ayushman Bharat – National Health Protection Mission will be an entitlement-based scheme with entitlement decided based on deprivation criteria in the SECC database.
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The beneficiaries can avail themselves of benefits in both public and impaneled private facilities.
To control costs, the payments for treatment will be done on a package rate (to be defined by the Government in advance) basis.
One of the core principles of Ayushman Bharat – National Health Protection Mission is to co-operative federalism and flexibility to states.
To give policy directions and fostering coordination between the Centre and States, it is proposed to set up Ayushman Bharat National Health Protection Mission Council (AB-NHPMC) at the apex level Chaired by Union Health and Family Welfare Minister.
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States would need to have State Health Agency (SHA) implement the scheme.
To ensure that the funds reach SHA on time, the transfer of funds from Central Government through Ayushman Bharat – National Health Protection Mission to State Health Agencies may be done through an escrow account directly.
In partnership with NITI Aayog, a robust, modular, scalable, and interoperable IT platform will be made operational which will entail a paperless, cashless transaction.