Maintaining proper health is a very important factor for the human body. Everyone of time needs to take medication for a better healthy life. Not everyone in this world has a healthy life. Some people need medical attention or need medical treatment for a better life. Some people can afford such medical expenses, while some cannot. Most of the poor people cannot afford Medical Expenses. For a healthy nation, a scheme has been initiated by the Prime Minister Narendra Modi on September 2018. We know this scheme as the Arogya Yojna – Ayushman Bharat. It is health insurance governed by the Indian government especially for the welfare of the poor people. This scheme aims at providing a health cover of Rs. 5 lakhs for a family per year. This scheme applies only when the affected people get hospitalised for 15 days and also includes 3 days of pre-hospitalisation. The very plus point in such a scheme is that, as it prevails a central government scheme, the E-card provided through that scheme can be accessed all over the nation, that is a citizen in Delhi can get treatment in Tamil Nadu same as in his home town with no negotiations. In this scheme, they can do payment after treatment.
What is Ayushman Bharat?
Ayushman Bharat is a scheme introduced by Prime Minister Shri Narendra Modi on September 2018. The aim of this scheme is to provide free access to health care for 40% of people in the country. Most of the poor people will get proper health care by this scheme as the Government takes the burden for their treatment and for their better life. In this way, most of them will lead a healthy life including poor people who can’t afford medical treatment. Every year over six crores they push Indians into poverty because of out of pocket medical expenses. Ayushman Bharat can avoid this. This scheme has two main pillars: strengthening of universal comprehensive primary health care and a health insurance scheme to cover 500 million people in need to reduce catastrophic out-of-pocket health spending. In the budget speech of 2018, the Ayushman Bharat for a new India 2022 was announced which included two major initiatives, namely creation of health and wellness centres (HWCs) and an ambitious National Health Protection Scheme (NHPS).
Health and Wellness Centres
Here, a larger and comprehensive package of primary health care will be given at the grassroots level by upgrading subcenters (SCs) to HWCs. It has now broadened the primary focus from preventive to promotive, curative and palliative care. Now the upgraded Subcenters or the health and wellness centres will have a point of care, physiotherapy and group meetings, wellness room for yoga, consultation space with full privacy, free diagnostics and pharmacy, facilities for telemedicine and waiting area for 30 plus persons. Package of services at HWC is also ambitious and includes common ophthalmic and ENT problems, mental health ailments, oral health, emergency medical services, elderly and palliative health, management of communicable and non-communicable diseases and general outpatient care; besides the reproductive, maternal, neonatal, child, and adolescent health services. It also includes the creation of electronic health records with the support of a robust IT system. Although not mentioned, they imply it that these HWCs will continue to play their current roles in all national health programs including malnutrition correction (all micronutrient/micronutrient deficiency) and vaccination. They staff SCs with one male and female health workers but HWCs will require other dedicated medical-paramedical staff. HWC will thus require a reorientation of staffing and infrastructure. The schemes aim to upgrade all SCs across the country, Prime Minister on April 14, 2018, in Odisha.
Ayushman Bharat National Health Protection Scheme
Based on Socio-Economic and Caste Census database, this centrally sponsored flagship scheme is aiming to provide an annual health cover of up to Rs.5 lakhs for the vulnerable 10 crores families that are 40% of the country’s population. The scheme will provide a cashless cover for identified secondary/tertiary treatments, in public/empanelled private facilities with no cap on family size and age. All pre-existing conditions will be covered from day one of the policy. The benefit cover will also include pre- and post-hospitalisation expenses and transport allowance.
NHPS will subsume the ongoing centrally sponsored schemes such as Rashtriya Swasthya Bima Yojana (RSBY) and the Senior Citizen Health Insurance Scheme. Dubbed as Modicare, the scheme would be the largest state-funded health insurance scheme and a massive leap forward toward UHC, by decreasing OOPE and protecting around 40% vulnerable population from the catastrophic health-care expenditure.
Critical Areas under Health and Wellness centre scheme
- For up-gradation of 1,50,000 Subcenters Rs.12000 crores budget has been allotted under the Health and Wellness Centre. Hoping it’s a recurring grant, it is still grossly insufficient to meet the logistics, human resources, and overhaul required to meet the expanded range of services. It needs to be noted that over 25% of the functioning Subcenter’s require buildings to be constructed. Deputing staff and lending existing infrastructure will only worsen the situation. This gap between policy intention and fund allocation needs to be addressed.
- They must also realise is that adding more and more services to grass-root/lower centres can prove detrimental because then they will under-serve their primary objectives (promotive and preventive) and ineffectively subserve the added responsibilities.
Critical Areas under Ayushman Bharat National Health Protection Scheme
- NHP 2017 aims to ensure UHC and reinforce the trust in the public health-care system by strengthening and expanding the services. It aims to increase government health expenditure as a percentage of gross domestic product from the current 1.15% to 2.5% by 2025. This means almost doubling the budgetary allocation in the next 6–7 years. It seems impossible, considering that 2018–2019 budgetary allocation (Rs. 52,800 crores) is only 2.4% higher over the last year. If adjusted for inflation (4% last year), it is a cutdown in the allocation. With its endorsement of the SDGs, India will have to constantly raise its ambition (and expenditure) during the dozen years to the deadline by raising not just core budgetary spending every year, but also toward social determinants of health (affordable housing, planned urban development, pollution control, road safety, etc.). Unfortunately, governments are paying little attention to these issues, as the quality of life erodes even with steady economic growth.
- In the current scenario, the annual premium of AB NHPS would be around Rs. 2000 per family to start with and would entail an expenditure of Rs. 20,000 crores (@ Rs. 2000 per family for 10 crore family).Yet, another estimate from Niti Aayog puts this annual requirement at Rs. 10,000 crores. This is in contrast to a similar Rashtriya Swasthya Suraksha Yojna proposed in Budget 2016 with an allocation of Rs 1,500 crore, to provide an annual cover of Rs. 1 lakh per economically weaker household. However, this never saw the light of the day. AB-NHPS, with five times the cover and higher number of beneficiaries, has been rolled out with allocation of Rs. 2,000 crores only. We propose this gap to be bridged by a matching contribution from the state governments. Please note that this premium will go up to Rs. 5,000 or more; depending on the maturity of the scheme and payouts in the long run.
- It bases the scheme on the concept of cooperative federalism. It will, therefore, be a challenge to achieve the desired goals unless all the different states agree to implement the scheme. The state’s contribution to this is expected to be around 40% i.e. over Rs. 4,000 crores (considering the conservative Niti Ayog estimate). Will the states, already in a fiscal noose, be ready to dole out the amount? They will complicate the situation as many states are implementing their own health insurance schemes which will need to be harmonised, besides the socio-political conflicts.
Reach of Ayushman Bharat
Till now 25 states and Union Territories of India have adopted the Ayushman Bharat scheme except three states: Odisha, Telangana and West Bengal and Union Territory Delhi. By June 2020, people have used this scheme, and they have recorded it that around 12.5 crore e-cards have been generated and over 1 crore people have taken benefit under this scheme.
Key Features of Ayushman Bharat
- Providing health coverage for 50 crores Indians
- It provides 5 lakhs per family per year for medical treatment in both private and public hospitals
- Offers cashless payments and paperless record-keeping in the hospital office.
- No restriction on family size, gender and age
- It covers all previous medical conditions under the scheme.
- 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
A scheme for the Government has started which is a step towards healthy India. It provides a health facility to all poor peoples. In this way, people in India will be healthy and get many a medical facility for a citizen of India. Ayushman Bharat has been a successful scheme and has provided health care facility to Indians. This is a step towards Healthy India and this will be achieved by 2025.
Frequently Asked Questions (FAQs)
- What is Ayushman Bharat?
- Why was this scheme introduced?
- What are the features of Ayushman Bharat?
- What are the main pillars of Ayushman Bharat?