PM Modi to roll out Ayushman Bharat scheme: All you need to know about healthcare scheme that has impressed WHO

Prime Minister Narendra Modi will roll out the Centre's flagship Ayushman Bharat ‘Pradhan Mantri Jan Aarogya Yojana (AB-PMJAY) in Ranchi today.

Under the vision of Ayushman Bharat, Pradhan Mantri Jan Aarogya Yojana (AB-PMJAY) shall be implemented so that each and every citizen receives his due share of healthcare. Health Minister JP Nadda has said that each family will receive Rs 5 lakh per annum under this scheme.

How to check if you're eligible? 

To understand why it’s such a huge move, one has to understand India’s current healthcare woes. Combined with malnutrition, India is facing direct threats on two fronts – infectious diseases like tuberculosis, malaria, H1N1 and drug-resistant TB and the emergence of non-communicable ‘lifestyle’ diseases like heart ailments, diabetes and cancer.

This has put the country’s arbitrarily distributed healthcare sector under pressure. It’s exacerbated by the fact that out-of-pocket expenditure on healthcare drove 55 million people in poverty in 2017.  

The scheme, if implemented properly could be a godsend. The identification will be done by Aadhaar and will allow follow-up services and health outcomes to evaluate the impact of the program.

The scheme is an extension of the Rashtriya Swasthya Bima Yojna or RSBY, a health insurance scheme for BPL families with entitlement up to Rs 30k per annum. Also, important will be the participation of states who are expected to pay around 40% share.

This year, FM Jaitley had allocated Rs 52,800 crore for health ministry, up by 11% and health minister JP Nadda Rs 2000 crore has been allocated as of now.

Even the World Health Organisation has been impressed by the attempt. "Very impressed with India's initiative on Ayushman Bharat or universal Health Coverage! Thank you Prime Minister @narendramodi. Great commitment! Thank you Minister of Health, @JPNadda, for meeting me today!," Director General Tedros Ghebreyesus tweeted.

On the other hand, critics believe that Ayushman Bharat alone can’t alleviate India’s healthcare woes and unless the state of the public health sector improves, it will only benefit private parties. In the long run, that will be unsustainable.

 Opposition Congress has already criticised the move, with P Chidambaram saying: Ayushman Bharat is an insurance based model. Government says it will pay the premium... Is that the right model for India? I don't think so. The right model for India is the one practiced in Europe, vast expansion of public facilities, more public hospitals, more super specialities, more tertiary hospitals, more dist level hospitals, more primary health centers, more doctors and nurses, more beds and free public health care. That's the way you can treat our 130 crore people. You can't go by an insurance model.”

However, there’s no denying that the scheme is the most ambitious healthcare project attempted in independent India.

At a glance

World’ ‘largest government-funded healthcare program’

This is considered to be the ‘world’s largest government-funded healthcare program’ targeting more than 50 crore beneficiaries.

10,73 crore families entitled for benefits

PMJAY will provide a cover of up to Rs. 5 lakhs per family per year, for secondary and tertiary care hospitalisation. Over 10.74 crore vulnerable entitled families (approximately 50 crore beneficiaries) will be eligible for these benefits.

Cashless and paperless access

The healthcare programme will provide cashless and paperless access to services for the beneficiary at the point of service. It will help reduce catastrophic expenditure for hospitalisation, which impoverishes people and will help mitigate the financial risk arising out of catastrophic health episodes.

Step towards Universal Health coverage

Entitled families will be able to use the 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).

Announcing the scheme on the occasion of the 72nd Independence Day, Prime Minister Modi had said, "Pradhan Mantri Jan Arogya Abhiyaan will be launched on September 25 this year. It is high time we ensure that the poor of India get proper access to good quality and affordable healthcare".

After the inauguration of the scheme, Prime Minister Modi will be visiting an exhibition on the PMJAY. He will also witness a demonstration of activities such as beneficiary identification and e-card creation.

The ambitious scheme, renamed the Pradhan Mantri Jan Arogya Abhiyan (PMJAY), aims to provide a coverage of Rs five lakh per family annually, benefiting more than 10.74 crore poor families for secondary and tertiary care hospitalisation through a network of Empanelled Health Care Providers. 

The scheme will provide cashless and paperless access to services for the beneficiary at the point of service. It will help reduce expenditure for hospitalisations which impoverishes people and will help mitigate the financial risk arising out of catastrophic health episodes. Eligible people can avail the benefits in government and listed private hospitals.

"71st Round of National Sample Survey Organization (NSSO) has found 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. Catastrophic healthcare related expenditure pushes families into debt. More than 24 per cent households in rural India and 18 per cent population in urban area have met their healthcare expenses through some sort of borrowing," an official statement said.

The scheme will target poor, deprived rural families and identified occupational category of urban workers' families, 8.03 crore in rural and 2.33 crore in urban areas, as per the latest Socio-Economic Caste Census (SECC) data. It will cover around 50 crore people. 

The entitlement is being decided on the basis of deprivation criteria in the SECC database. The beneficiaries are identified based on the deprivation categories (D1, D2, D3, D4, D5, and D7) identified under the SECC database for rural areas. For the urban areas, the 11 occupational criteria will determine entitlement. 

In addition, the Rashtriya Swasthya Bima Yojna (RSBY) beneficiaries in states where it is active are also included. 

There is no cap on family size and age in the scheme, ensuring that nobody is left out. One would only need to establish one's identity to avail benefits under the scheme and it could be through Aadhaar card or election ID card or ration card. Having an Aadhaar card is not mandatory.

In case of hospitalisation, members of the beneficiary families do not need to pay anything under the scheme, provided one goes to a government or an empanelled private hospital.

"The objectives 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 statement stated.

The National Health Agency (NHA), the apex body implementing the AB-NHPM, has launched a website and a helpline number to help prospective beneficiaries check if their name is there in the final list. 

One can visit mera.pmjay.gov.in or call up the helpline (14555) to check their enrolment. A beneficiary needs to key in his or her mobile number, which is verified through an OTP and then complete the KYC (know your customer) online without any need for human interface with other documents. 

Each empanelled hospital will have an 'Ayushman Mitra' to assist patients and will coordinate with beneficiaries and the hospital. They will run a help desk, check documents to verify the eligibility and enrolment to the scheme.

All the beneficiaries will be given letters having QR codes which will be scanned and a demographic authentication conducted for identification and to verify his or her eligibility to avail the benefits of the scheme. 

The Health Ministry has included 1,354 packages in the scheme under which treatment for coronary bypass, knee replacements and stenting, among others, would be provided at 15-20 per cent cheaper rates than the Central Government Health Scheme (CGHS).

Modi had announced the launch of the scheme from ramparts of the Red Fort during his Independence day speech. As many as 30 states and Union Territories have signed MoUs with the Centre and will implement the programme over the next two to three months, after its launch Sunday.

Remaining states and UTs which include Telangana, Odisha, Delhi, Kerala and Punjab have not signed, so the scheme will not be implemented there till they come on board.

So far 15,686 applications for hospital empanelment have been received and over 8,735 hospitals, both public and private, have been empanelled for the scheme. 

"The prime minister will launch the scheme on September 23 but effectively it will become operational from September 25 on the birth anniversary of Pandit Deendayal Upadhyay," said Niti Aayog member V K Paul, who is the chief architect of the scheme.

He said in the current fiscal, the burden on the Centre is likely to be around Rs 3,500 crore. Billed as the world's largest government healthcare programme, it will be funded with 60 per cent contribution coming from the Centre and remaining from the states.

"We have received applications from 15,000 hospitals for being empanelled...Out of this half, that means 7,500 applications for empanelment are private hospitals," Paul said.

Detailed guidelines have been prepared to address the issues around potential fraudulent activities that could be committed by any individual or organisation. Pilot launch of the scheme has started and it involves over 1280 hospitals.

With inputs from PTI