PM launches universal health insurance programme Ayushman Bharat

Announcing the launch of the universal health insurance programme during a function at Ranchi, Jharkhand, the prime minister said the implementation of vision Ayushman Bharat will ensure that each and every citizen receives his due share of health care. 

“With Ayushman Bharat – Pradhan Mantri Jan AarogyaYojana - the government is taking healthcare protection to a new aspirational level. This is the “world’s largest government funded healthcare program” targeting more than 500 million beneficiaries,” an official release stated.

Ayushman Bharat- Pradhan Mantri Jan ArogyaYojana (PMJAY) will provide a cover of up to Rs5 lakh per family per year, for secondary and tertiary care hospitalisation. 

An estimated 107.4 million vulnerable families (approximately 500 million beneficiaries) will be eligible for these benefits.

PMJAY will provide cashless and paperless access to services for the beneficiary at the point of service.

PMJAY will help reduce catastrophic expenditure for hospitalisations, which impoverishes people and will help mitigate the financial risk arising out of catastrophic health episodes.

Entitled families will be able to use quality health services they need without facing financial hardships.

When fully implemented, PMJAY will become the world’s largest fully government-financed health protection scheme. It is a visionary step towards advancing the agenda of Universal Health Coverage (UHC).

Ayushman Bharat is a progression towards promotive, preventive, curative, palliative and rehabilitative aspects of universal healthcare through access to health and wellness centers (HWCs) at the primary level and provision of financial protection for accessing curative care at the secondary and tertiary levels through engagement with both public and private sector.

It adopts a continuum of care approach, comprising two inter-related components - creation of 1,50,000 health and wellness centres which will bring health care closer to the homes of the people.

These centres will provide comprehensive primary health care (CPHC), covering both maternal and child health services and non-communicable diseases, including free essential drugs and diagnostic services. The prime minister launched the first health and wellness centre at Jangla, Bijapur, Chhatisgarh on 14 April 2018.

The second component is the Pradhan Mantri Jan ArogyaYojana (PMJAY), which provides health protection cover to poor and vulnerable families for secondary and tertiary care.

The health and wellness centres will play a critical role in creating awareness about PMJAY, screening for non-communicable diseases, follow-up of hospitalisation cases among others. 

The 71st round of National Sample Survey has found that:

·        85.9 per cent of rural households and 82 per cent of urban households have no access to healthcare insurance/assurance; 

·        More than 17 per cent of Indian population spend at least 10 per cent of household budgets for health services; and 

·        Catastrophic healthcare related expenditure pushes families into debt, with more than 24 per cent households in rural India and 18 per  ent population in urban area have met their healthcare expenses through some sort of borrowings.

PMJAY primarily targets the poor, deprived rural families and identified occupational category of urban workers’ families as per the latest Socio-Economic Caste Census (SECC) data for both rural and urban areas as well as the active families under the Rashtriya Swasthya Bima Yojana (RSBY).

Approximately 107.4 million identified families (approximately 500 million beneficiaries) will be entitled to get the benefits. There is no cap on family size and age as well as restriction on pre-existing conditions.

The Pradhan Mantri Jan ArogyaYojana offers hospitalisation cover - from inpatient care to post hospitalisation care.

The objectives of the Yojana are to reduce out of pocket hospitalisation expenses, fulfil unmet needs and improve access of identified families to quality inpatient care and day care surgeries.

The Yojana will provide a coverage up to Rs5,00,000 per family per year, for secondary and tertiary care hospitalisation through a network of Empanelled Health Care Providers (EHCP).

The EHCP network will provide cashless and paperless access to services for the beneficiaries at the both public and private hospitals.

The services will include 1,350 procedures covering pre and post hospitalisation, diagnostics, medicines etc.

The Yojana beneficiaries will be able to move across states and access services throughout the country through the provider network seamlessly.

The scheme has been formulated with stakeholder inputs taken from all states and UTs through the national conclaves, sectoral working groups, intensive field exercises and piloting of key modules.

The scheme is principle-based rather than rule-based, allowing states enough flexibility in terms of packages, procedures, scheme design, entitlements as well as other guidelines while ensuring that key benefits of portability and fraud detection are ensured at a national level.

States have the option to use an existing trust/society or set up a new trust/society to implement the scheme as State Health Agency and will be free to choose the modalities for implementation.

States can implement the scheme through an insurance company or directly through the trust/society/implementation support agency or a mixed approach.

30 states and UTs have signed the MoU and have started working on implementation of the mission. 

Pilot launch of the scheme has started. The focus of the pilot launch of the mission is to test and enhance the developed IT systems and streamline the state preparedness for a comprehensive launch.

The pilot been done in around 22 states / UTs (Arunachal Pradesh, Chandigarh, Chhattisgarh, Dadra & Nagar Haveli, Daman & Diu, Haryana, Himachal Pradesh, Madhya Pradesh, Manipur, Meghalaya, Mizoram, Nagaland, Uttarakhand, West Bengal, Uttar Pradesh, Jammu & Kashmir, Goa, Maharashtra among others).

The pilot launch is taking place in specific hospitals to test the Beneficiary Identification System (BIS) and Transaction Management System (TMS) systems.

The pilot launch involves over 1,280 hospitals.

The scheme is creating a cadre of certified frontline health service professionals called Pradhan Mantri Aarogya Mitras (PMAMs) who will be primary point of facilitation for the beneficiaries to avail treatment at the hospital and thus, act as a support system to streamline health service delivery.

Training has already been conducted in across 20 states and around 3,519 Aarogya Mitras have been trained so far. Training programmes for state, district and PMAMs have been conducted in 27 states.

A total of around 3,936 personnel have been trained at state, district and PMAM levels.

So far 15,686 applications for hospital empanelment have been received.