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Features and Analysis of Ayushman Bharat Scheme

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  • Last Updated : 10 Aug, 2022
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The Government of India introduced the ‘Ayushman Bharat program in 2018 (as defined in the National Health Policy 2017) to make healthcare services more accessible and affordable to residents, and to help the country meet its aim of universal health coverage (UHC) by 2030.

Ayushman Bharat has been created to achieve the SDGs and its underlying promise to “leave no one behind.” Ayushman Bharat is an endeavor to transform from a sectoral and divided approach to healthcare delivery to a comprehensive, need-based method. It aspires to implement ground-breaking programs to address health issues comprehensively (including prevention, promotion, and ambulatory care) at the basic, intermediate, and higher levels.

The two important characteristics of ‘Ayushman Bharat‘ are as follows:

A. Establish Health and Wellness Centres (HWCs):

The initiative, which was launched in February 2018, aimed to provide quality health services to individuals closer to their homes by creating 1,50,000 Health and Wellness Centres (HWCs).

B. Pradhan Mantri Jan Arogya Yojana (PM-JAY): 

The initiative, which was launched in September 2018, aimed to provide hospital and community services to society’s most needy members. More than 10.74 crore poor and vulnerable families, or the bottom 40% of India’s population, were to receive medical coverage of Rs. 5 lakh per family per year for secondary and tertiary care hospitalization under the scheme.

PM-JAY will cover practically all secondary care and most tertiary care treatments’ medical and hospitalization costs. PM-JAY has defined 1,350 medical packages that include surgery, medical and daycare treatments, medications, diagnostics, and transportation.

Features of the Ayushman Bharat:

  1. It is the world’s largest medical insurance plan, funded by the Indian government.
  2. The maximum coverage amount is Rs 5 lakh.
  3. Pre-hospitalization coverage is for three days, and post-hospitalization coverage is for fifteen days, including medications and diagnostics.
  4. Hospitalization in both secondary and tertiary care is covered.
  5. Beneficiaries are provided with cashless hospitalization coverage.
  6. It starts on the first day and covers pre-existing diseases.
  7. The system has no age, family size, or gender restrictions.
  8. It includes over 1,393 treatments, including the treatment cost, accommodation costs, doctor’s fees, operating room, intensive care unit, diagnostic services, surgeon charges, and so on.
  9. In India, hospitalization coverage is available at both private and public panel hospitals.

Benefits of the Ayushman Bharat:

  1. Ayushman Bharat Yojana (PM-JAY) offers beneficiaries coverage of up to Rs 5 lakh as well as cashless medical treatment in both public and private hospitals in India. 
  2. Every household in India that meets the Ayushman Bharat Yojana qualifying criteria can have this money covered for specific secondary and tertiary care problems.
  3. It assists families by providing access to healthcare services and financial aid for daycare treatments, including pre-existing diseases. 
  4. Across India, the plan covers over 1,350 medical packages at both public and commercial network hospitals.
  5. Accommodation while in the hospital.
  6. Everyone in the family may use it.
  7. Pre-existing conditions are covered from the start.
  8. Pre- and post-hospitalization expenses
  9. It covers all hospitalization expenditures for beneficiaries through cashless transactions.
  10. Covers any difficulties that arise during therapy.
  11. There are no limitations on age, gender, or family size.

Eligibility for Ayushman Bharat Card:

The following criteria must be met in order to be eligible for an Ayushman Card:

  1. Families without an adult member earning for their home between the ages of 16 and 59 will be issued the Card.
  2. Female heads of families who do not have any male adults between the ages of 16 and 59 will be given assistance.
  3. To those who fall within the Scheduled Castes and Scheduled Tribes categories
  4. The Card is given to household members who are handicapped and have no other family members who can financially assist them.
  5. Households that are often landless and rely on manual labor as a source of basic income are thus eligible for the Ayushman Bharat Card.
  6. The houses are made out of a single room with temporary access to the walls and roofing.
  7. Homes whose families depend on donations, families of laborers, houses that do not even have enough shelter for their livelihood, families of bonded laborers, and primitive and vulnerable tribal groups are all granted access to the Card.

The following are the Eligibility Conditions in Urban Areas:

  1. Families with members who work as street vendors, craft workers, or food stalls.
  2. To the garbage collectors and homeless.
  3. To family members who work as construction workers, security guards, or plumbers.
  4. Families who depend on domestic workers.

The following beneficiaries are excluded from the Ayushman Bharat scheme per the Socio-Economic Caste Census 2011:

  1. According to SECC 2011, households with a member who works for the government, a motorized two-, three-, or four-wheeled vehicle, a fishing boat, a mechanized three- or four-wheeled piece of agricultural equipment, a Kisan Credit Card with a credit limit above Rs. 50,000, and households with non-agricultural enterprises registered with the government are automatically excluded.
  2. According to SECC 2011, households that usually contain 7.5 acres of land with at least one irrigation equipment, own more than 2.5 acres of irrigated land with at least one irrigation equipment or own five acres or more of irrigated land for two or more crop seasons are also excluded.
  3. Those who pay income tax, professional tax, have three or more rooms with pucca walls and roofs, a refrigerator, and a landline phone are also excluded, the statement stated.

Registration Process for Ayushman Card

  1. Visit https://pmjay.gov.in
  2. Click on the “Am I Eligible?” button.
  3. After that, enter your mobile phone number.
  4. Then, complete and submit the Ayushman Bharat Card Application Form.
  5. Now, submit the form and wait for confirmation from the appropriate authorities.

After your application is approved, you will be able to download a PDF of your Ayushman Bharat Card. 

The Shortcomings of Ayushman Bharat Yojana:

  1. India is a growing nation, and as it moves towards a more wealthy nation, the burden of lifestyle diseases like diabetes and heart disease is rising, while hospitals are already overworked from treating communicable illnesses like TB and malaria.
  2. Even though the card is given to the family’s head under the program, any number of family members may sign up to get benefits. As a result, those who do not fit the requirements for Ayushman Bharat may either obtain a card for themselves using a fake poverty certificate or claim a fraudulent link to someone who already has one.
  3. The deficiencies in the fundamental infrastructure and services in HWCs have largely stayed the same, despite the inclusion of non-communicable illnesses in comprehensive care. This will put further strain on public hospitals and super-specialty clinics and push the poor to choose expensive private treatments that, after a certain point, they can’t afford.
  4. Under Ayushman Bharat, the prices specified for various treatments are moderate. As a result, services may eventually become less effective or even unprofitable for hospitals. States including Odisha, Delhi, Telangana, Kerala, and Punjab have chosen to opt out because of this.
  5. The program doesn’t cover those economically vulnerable groups that work in the organized sector and don’t have access to health insurance. These families may become impoverished as a result of significant or unforeseen medical expenses, a problem India has been combating since its independence.

Related Frequently Asked Questions and Answers:

1Q. What function does the Ayushman Card Serve?

Ans: Ayushman Bharat Pradhan Mantri Jan Arogya Yojana is the common name for the Ayushman Card. In September 2018, the Ministry of Health and Family Welfare inaugurated the initiative. This is a health insurance fund established by the Prime Minister of India for the benefit of the people.

2Q. When was the Ayushman Bharat Scheme Started?

Ans: The Government of India introduced the ‘Ayushman Bharat program in 2018 (as defined in the National Health Policy 2017) to make healthcare services more accessible and affordable to residents, and to help the country meet its aim of universal health coverage (UHC) by 2030.

3Q. What are the Benefits of Ayushman Bharat?

Ans:

  1. Ayushman Bharat Yojana (PM-JAY) offers beneficiaries coverage of up to Rs 5 lakh as well as cashless medical treatment in both public and private hospitals in India. 
  2. Every household in India that meets the Ayushman Bharat Yojana qualifying criteria can have this money covered for specific secondary and tertiary care problems.
  3. It assists families by providing access to healthcare services and financial aid for daycare treatments, including pre-existing diseases. 

4Q. What is the Eligibility of the Ayushman Bharat Scheme?

Ans: 

  1. Families without an adult member earning for their home between the ages of 16 and 59 will be issued the Card.
  2. Female heads of families who do not have any male adults between the ages of 16 and 59 will be given assistance.
  3. To those who fall within the Scheduled Castes and Scheduled Tribes categories
  4. The Card is given to household members who are handicapped and have no other family members who can financially assist them.
  5. Households that are often landless and rely on manual labor as a source of basic income are thus eligible for the Ayushman Bharat Card.
  6. The houses are made out of a single room with temporary access to the walls and roofing.
  7. Homes whose families depend on donations, families of laborers, houses that do not even have enough shelter for their livelihood, families of bonded laborers, and primitive and vulnerable tribal groups are all granted access to the Card.

5Q. Write about the Pradhan Mantri Jan Arogya Yojana?

Ans: PM-JAY initiative, which was launched in September 2018, aimed to provide hospital and community services to society’s most needy members. More than 10.74 crore poor and vulnerable families, or the bottom 40% of India’s population, were to receive medical coverage of Rs. 5 lakh per family per year for secondary and tertiary care hospitalization under the scheme.

 


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