AYUSHMAN BHARAT YOJANA

Post Date: Friday, June 14, 2019

Date: 14.06.2019

Report prepared by Niyati Bhardwaj   

 

AYUSHMAN BHARAT YOJANA

Prime Minister Shri Narendra Modi, in his Independence Day speech of 2018, announced the launch of the Ayushman Bharat-National Health Protection Scheme (AB-NHPS). He said that the national health insurance scheme will be rolled out on a pilot basis in some states. 
It is the world’s largest government-funded healthcare program. The government provides health insurance coverage of up to Rs. 5 lakh per annum per family. It will provide health insurance to more than 10.74 crore poor and vulnerable families (approximately 50crore beneficiaries) across the country.All members of families listed in the SECC database as per defined criteria are automatically covered. No restriction on number of family members and age of members. Ayush Yojana is entitlement based. No enrolment or registration needed. Priority will be given to girl child, women and senior citizens.You will get free treatment at public hospitals and empanelled private hospitals across the country in times of need.The scheme will covers secondary and tertiary care hospitalization. PMJAY provides cashless and paperless access to quality health care services for the beneficiary at the point of service.1,350 medical packages are included in this scheme covering surgery, medical and day care treatments, cost of medicines and diagnostics.All pre-existing diseases are covered from day one of the policy. Hospitals cannot deny treatment.Hospitals will not charge any additional money from beneficiaries for the treatment. Eligible beneficiaries can avail services across the country, offering benefit of national portability. All empanelled hospital will have “Ayushman Mitra Help Desk” for assistance.You need to carry any prescribed ID to receive treatment at the hospital.You can reach out for information, assistance, complaints and grievances to a 24X7 helpline number – 14555.[1]

List of services to be provided at health and wellness centre are– Pregnancy care and maternal health services, Neonatal and infant health services, Child health, Chronic communicable diseases, Non-communicable diseases, Management of mental illness, Dental care, Eye care, Geriatric care Emergency medicine.

It is an umbrella of two major health initiatives, the Health and Wellness Centres (HWCs) and Pradhan Mantri Jan Arogya Yojana (PMJAY).[2]

(i) Health and Wellness Centre:- The National Health Policy, 2017 has envisioned Health and Wellness Centres as the foundation of India’s health system. Under this 1.5 lakh centres will bring health care system closer to the homes of people. These centres will provide comprehensive health care, including for non-communicable diseases and maternal and child health services.  These centres will also provide free essential drugs and diagnostic services. The Budget has allocated Rs.1200 crore for this flagship programme. Contribution of private sector through CSR and philanthropic institutions in adopting these centres is also envisaged.

(ii) National Health Protection Scheme:- The second flagship programme under Ayushman Bharat is National Health Protection Scheme, which 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.  This will be the world’s largest government funded health care programme. Adequate funds will be provided for smooth implementation of this programme.                                                                           

The Finance Minister further said, that these two health sector initiatives under Ayushman Bharat Programme will build a New India 2022 and ensure enhanced productivity, well being and avert wage loss and impoverishment. These Schemes will also generate lakhs of jobs, particularly for women.

The Finance Minister said, that in order to further enhance accessibility of quality medical education and health care, 24 new Government Medical Colleges and Hospitals will be set up, by up-grading existing district hospitals in the country. This would ensure that there is at least 1 Medical College for every 3 Parliamentary Constituencies and at least 1 Government Medical College in each State of the country.[3]

People received money through this scheme and how many hospitals are empanelled under the scheme.

The government has allocated Rs 6,400 crore for the Pradhan Mantri Jan Arogya Yojana (PMJAY) for 2019-20. Known popularly as Ayushman Bharat, the health scheme received a Rs 4,000-crore boost from the last fiscal. 

Finance minister Piyush Goyal said on 1st February 2019 that 10 lakh patients have been treated so far under the scheme and highlighted the setting up of new All India Institutes of Medical Sciences (AIIMS). There has been a reduction in the cost of cardiac stents, knee implants and other medicines.

  • Total budget allocated to the health ministry for 2019-20 is Rs. 61,398.12 crore, a rise of 16.3% from the FY19 budget
  • Ayushman Bharat’s budget increases by over 166% from Rs. 2,400 crore in 2018-19 to Rs. 6,400 crore

Over 12 lakh people have received free treatment under the Ayushman Bharat – Pradhan Mantri Jan Arogya Yojana, while around two crore beneficiary e-cards have been issued since its launch in September last year, Dr Indu Bhushan, the CEO of Ayushman Bharat on 22nd February. At least 15,474 hospitals have so far been empanelled under the scheme out of which, 15 per cent are private hospitals, he said, urging more healthcare establishments to join the movement.[4]

Finance Minister Arun Jaitley took to social media to highlight of achievements of the programme.”In the first 100 days, 6.85 lakh patients have been provided hospital treatment. 5.1 lakh claims have availed of the scheme, for which payment has been released. This averages 5,000 claims per day for the first 100 days. No patient has had to pay a single rupee,” he tweeted on 29th march 2019.[5]

According to The Financial Express, so far, 5.29 lakh hospitalisation claims have been filed under the Ayushman Bharat scheme worth about Rs 684.6 crore. So the average hospitalisation cost works out to Rs12, 932 per patient. However, government think tank NITI Aayog has estimated the average cost to come down to about Rs 10,000 as the scheme matures.

ABY has completed 250 days at the end of May (it was launched on September 23, 2018), has proved a good augury for the highly fragmented small and medium enterprises (SMEs) in the hospital segment.

The scheme has helped improve health care penetration in terms of both number of people covered and amount of health care assurance, with nearly 15,224 hospitals empanelled and nearly 26 lakh treatments sought so far.

Significantly, around 49 per cent of the hospitals empanelled under the scheme are private ones, which together account for about 64 per cent of the admissions.[6]

TARGET GROUP FOR RURAL:

Total deprived Households targeted for AB PM-JAY who belong to one of the six deprivation criteria amongst D1, D2, D3, D4, D5 and D7:

  • D1: Only one room with kucha walls and kucha roof
  • D2: No adult member between age 16 to 59
  • D3: Female headed households with no adult male member between age 16 to 59
  • D4: Disabled member and no able-bodied adult member (D4)
  • D5: SC/ST households (D5)
  • D7: Landless households deriving major part of their income from manual casual labour

Automatically included-

  • Households without shelter • Destitute/ living on alms • Manual scavenger families • Primitive tribal groups • Legally released bonded labour[7]

TARGET GROUP FOR URBAN:

Occupational Categories of Workers: Rag picker/ Beggar/ Domestic worker/ Street vendor/ Cobbler/hawker/ Other service provider working on streets/ Construction worker/ Plumber/ Mason/ Labour/ Painter/ Welder/ Security guard/ Coolie and another head-load worker / Sweeper/ Sanitation worker / Mali /Home-based worker/ Artisan/ Handicrafts worker / Tailor /Transport worker/ Driver/ Conductor/ Helper to drivers and conductors/ Cart puller/ Rickshaw puller/ Shop worker/ Assistant/ Peon in small establishment/ Helper/Delivery assistant / Attendant/ Waiter/ Electrician/ Mechanic/ Assembler/ Repair worker/Washer-man/ Chowkidar[8].

YOJANA RULED OUT IN DELHI:

Touted to be the world’s largest, PM Narendra Modi’s ambitious healthcare scheme Ayushman Bharat somehow couldn’t gain the confidence of five Opposition-ruled states in the country. The governments of Telangana, Odisha, Delhi, Kerala and Punjab remained opposed to implementing the scheme. The state governments either pointed out flaws in the scheme or contended that they have better ones in place already. For example, Naveen Patnaik-led Odisha government contested that they have Biju Swasthya Kalyan Yojana which covers many more people than Ayushman Bharat and provides Rs 7 lakh to women as opposed to Rs 5 lakh in centre’s programme. Modi took an exception to this and accused Patnaik of ignoring a programme that is bound to help his state. However, the chief minister hit back at Modi saying that prime minister must focus his energies on curbing the rising prices of fuel in the country instead of picking on a state that already has a good health care programme.

Similar claims were made by Telangana which rejected the scheme arguing that its Aarogyasri scheme covers 70 per cent of the state’s population, while the Ayushman Bharat will benefit a mere 80 lakh people.

The scheme, which calls for a 60:40 funding between centre and state, was termed as a hoax by the Kerala government. In an interview with The Indian Express, State Finance Minister Thomas Isaac has recently raised questions on the “feasibility” terming it an “obvious hoax”. In his interview, Isaac wondered how the government would implement the scheme at such a big scale. “The subsidy ceiling for the current RSBY scheme of Rs. 30,000 benefit is Rs. 1,250. The subsidy for the Ayushman scheme, with benefits of Rs. 5 lakh, is Rs. 1,110. Is it possible to have such a jump in benefits for a lower premium?” he had said.

CM Arvind Kejriwal-led Delhi government has rejected to implement as it targets 6 lakh families, which is just 3 per cent of its 2-crore population.

Amarinder Singh’s led Punjab government also held similar reservations. Punjab had written to the centre says it will sign the Memorandum of Understanding to operationalise the scheme only after it gets clarity on the flow of finances.[9]

Prime Minister Narendra Modi on September 23 launched the Pradhan Mantri Jan Arogya Yojana (PMJAY)-Ayushman Bharat and termed it a “game-changer initiative to serve the poor”.

However, the scheme, which aims to provide a coverage of Rs 5 lakh per family annually, will not cover five states — Delhi, Kerala, Odisha, Punjab and Telangana. These states have opted out of the scheme.[10]

Delhi is not among the states and union territories that have signed a Memorandum of Understanding (MoU) with the Centre to implement the healthcare programme.

Chief Minister and AamAadmi Party (AAP) National Convener Arvind Kejriwal has claimed the scheme is a public relations exercise which will prove to be another jumla (rhetoric).

On September 23, AAP termed the scheme “another white elephant in the making” and alleged that it covers only six lakh out of 50 lakh families in Delhi.

It further claimed that the ‘Delhi model’ of healthcare is better than the Centre’s PMJAY.[11]

Newly updated on 8th June 2019

The Centre and the Delhi government continue to be at loggerheads over the implementation of the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY), the Narendra Modi-led National Democratic Alliance (NDA) government’s flagship health scheme.

While newly appointed Union Minister of Health and Family Welfare Harsh Vardhan earlier this week urged four states, including Delhi, to implement the scheme, Delhi chief minister Arvind Kejriwal had said the national capital will not adopt the scheme. Kejriwal had claimed that the Delhi government’s health scheme was 10 times better than AB-PMJAY.

Arvind Kejriwal argued in his letter to the union health minister that AB-PMAJY was available to only those with incomes less than ₹10,000 per month when the minimum wage of a daily labourer in Delhi was higher than that. He also said that the existing scheme extended health benefits to all 2 crore citizens of the national capital.[12]

CRITICISM OF AYUSHMAN BHARAT YOJANA:

Currently, access to health services varies significantly across Indian states. At the national level, India only has 0.62 doctors for every 1,000 population, as opposed to the World Health Organization standard of 1 doctor per 1,000 population. However, at the state level, Karnataka, Tamil Nadu, Kerala, Punjab, Goa, and Delhi have more than 1 doctor for every 1,000 people. In fact, Tamil Nadu and Delhi have 1 doctor for every 253 and 334 persons respectively. Such a high density of doctors in these states puts them at par with countries such as Norway and Sweden in terms of access to healthcare. In comparison, Jharkhand, Haryana and Chhattisgarh have only 1 doctor for every 6,000 persons, which greatly reduces the accessibility of healthcare in these states.[13]

AYUSHMAN BHARAT YOJANA

Prime Minister Shri Narendra Modi, in his Independence Day speech of 2018, announced the launch of the Ayushman Bharat-National Health Protection Scheme (AB-NHPS). He said that the national health insurance scheme will be rolled out on a pilot basis in some states. 
It is the world’s largest government funded healthcare program.Government provides health insurance coverage of up to Rs. 5 lakh per annum per family.It will provide health insurance to more than 10.74 crore poor and vulnerable families (approximately 50crore beneficiaries) across the country.All members of families listed in the SECC database as per defined criteria are automatically covered. No restriction on number of family members and age of members. Ayush Yojana is entitlement based. No enrolment or registration needed. Priority will be given to girl child, women and senior citizens.You will get free treatment at public hospitals and empanelled private hospitals across the country in times of need.The scheme will covers secondary and tertiary care hospitalization. PMJAY provides cashless and paperless access to quality health care services for the beneficiary at the point of service.1,350 medical packages are included in this scheme covering surgery, medical and day care treatments, cost of medicines and diagnostics.All pre-existing diseases are covered from day one of the policy. Hospitals cannot deny treatment.Hospitals will not charge any additional money from beneficiaries for the treatment. Eligible beneficiaries can avail services across the country, offering benefit of national portability. All empanelled hospital will have “Ayushman Mitra Help Desk” for assistance.You need to carry any prescribed ID to receive treatment at the hospital.You can reach out for information, assistance, complaints and grievances to a 24X7 helpline number – 14555.[1]

List of services to be provided at health and wellness centre are– Pregnancy care and maternal health services, Neonatal and infant health services, Child health, Chronic communicable diseases, Non-communicable diseases, Management of mental illness, Dental care, Eye care, Geriatric care Emergency medicine.

It is an umbrella of two major health initiatives, the Health and Wellness Centres (HWCs) and Pradhan Mantri Jan Arogya Yojana (PMJAY).[2]

(i) Health and Wellness Centre:- The National Health Policy, 2017 has envisioned Health and Wellness Centres as the foundation of India’s health system. Under this 1.5 lakh centres will bring health care system closer to the homes of people. These centres will provide comprehensive health care, including for non-communicable diseases and maternal and child health services.  These centres will also provide free essential drugs and diagnostic services. The Budget has allocated Rs.1200 crore for this flagship programme. Contribution of private sector through CSR and philanthropic institutions in adopting these centres is also envisaged.

(ii) National Health Protection Scheme:- The second flagship programme under Ayushman Bharat is National Health Protection Scheme, which 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.  This will be the world’s largest government funded health care programme. Adequate funds will be provided for smooth implementation of this programme.                                                                           

The Finance Minister further said, that these two health sector initiatives under Ayushman Bharat Programme will build a New India 2022 and ensure enhanced productivity, well being and avert wage loss and impoverishment. These Schemes will also generate lakhs of jobs, particularly for women.

The Finance Minister said, that in order to further enhance accessibility of quality medical education and health care, 24 new Government Medical Colleges and Hospitals will be set up, by up-grading existing district hospitals in the country. This would ensure that there is at least 1 Medical College for every 3 Parliamentary Constituencies and at least 1 Government Medical College in each State of the country.[3]

People received money through this scheme and how many hospitals are empanelled under the scheme.

The government has allocated Rs 6,400 crore for the Pradhan Mantri Jan Arogya Yojana (PMJAY) for 2019-20. Known popularly as Ayushman Bharat, the health scheme received a Rs 4,000-crore boost from the last fiscal. 

Finance minister Piyush Goyal said on 1st February 2019 that 10 lakh patients have been treated so far under the scheme and highlighted the setting up of new All India Institutes of Medical Sciences (AIIMS). There has been a reduction in the cost of cardiac stents, knee implants and other medicines.

  • Total budget allocated to the health ministry for 2019-20 is Rs. 61,398.12 crore, a rise of 16.3% from the FY19 budget
  • Ayushman Bharat’s budget increases by over 166% from Rs. 2,400 crore in 2018-19 to Rs. 6,400 crore

Over 12 lakh people have received free treatment under the Ayushman Bharat – Pradhan Mantri Jan Arogya Yojana, while around two crore beneficiary e-cards have been issued since its launch in September last year, Dr Indu Bhushan, the CEO of Ayushman Bharat on 22nd February. At least 15,474 hospitals have so far been empanelled under the scheme out of which, 15 per cent are private hospitals, he said, urging more healthcare establishments to join the movement.[4]

Finance Minister Arun Jaitley took to social media to highlight of achievements of the programme.”In the first 100 days, 6.85 lakh patients have been provided hospital treatment. 5.1 lakh claims have availed of the scheme, for which payment has been released. This averages 5,000 claims per day for the first 100 days. No patient has had to pay a single rupee,” he tweeted on 29th march 2019.[5]

According to The Financial Express, so far, 5.29 lakh hospitalisation claims have been filed under the Ayushman Bharat scheme worth about Rs 684.6 crore. So the average hospitalisation cost works out to Rs12, 932 per patient. However, government think tank NITI Aayog has estimated the average cost to come down to about Rs 10,000 as the scheme matures.

ABY has completed 250 days at the end of May (it was launched on September 23, 2018), has proved a good augury for the highly fragmented small and medium enterprises (SMEs) in the hospital segment.

The scheme has helped improve health care penetration in terms of both number of people covered and amount of health care assurance, with nearly 15,224 hospitals empanelled and nearly 26 lakh treatments sought so far.

Significantly, around 49 per cent of the hospitals empanelled under the scheme are private ones, which together account for about 64 per cent of the admissions.[6]

TARGET GROUP FOR RURAL:

Total deprived Households targeted for AB PM-JAY who belong to one of the six deprivation criteria amongst D1, D2, D3, D4, D5 and D7:

  • D1: Only one room with kucha walls and kucha roof
  • D2: No adult member between age 16 to 59
  • D3: Female headed households with no adult male member between age 16 to 59
  • D4: Disabled member and no able-bodied adult member (D4)
  • D5: SC/ST households (D5)
  • D7: Landless households deriving major part of their income from manual casual labour

Automatically included-

  • Households without shelter • Destitute/ living on alms • Manual scavenger families • Primitive tribal groups • Legally released bonded labour[7]

TARGET GROUP FOR URBAN:

Occupational Categories of Workers: Rag picker/ Beggar/ Domestic worker/ Street vendor/ Cobbler/hawker/ Other service provider working on streets/ Construction worker/ Plumber/ Mason/ Labour/ Painter/ Welder/ Security guard/ Coolie and another head-load worker / Sweeper/ Sanitation worker / Mali /Home-based worker/ Artisan/ Handicrafts worker / Tailor /Transport worker/ Driver/ Conductor/ Helper to drivers and conductors/ Cart puller/ Rickshaw puller/ Shop worker/ Assistant/ Peon in small establishment/ Helper/Delivery assistant / Attendant/ Waiter/ Electrician/ Mechanic/ Assembler/ Repair worker/Washer-man/ Chowkidar[8].

YOJANA RULED OUT IN DELHI:

Touted to be the world’s largest, PM Narendra Modi’s ambitious healthcare scheme Ayushman Bharat somehow couldn’t gain the confidence of five Opposition-ruled states in the country. The governments of Telangana, Odisha, Delhi, Kerala and Punjab remained opposed to implementing the scheme. The state governments either pointed out flaws in the scheme or contended that they have better ones in place already. For example, Naveen Patnaik-led Odisha government contested that they have Biju Swasthya Kalyan Yojana which covers many more people than Ayushman Bharat and provides Rs 7 lakh to women as opposed to Rs 5 lakh in centre’s programme. Modi took an exception to this and accused Patnaik of ignoring a programme that is bound to help his state. However, the chief minister hit back at Modi saying that prime minister must focus his energies on curbing the rising prices of fuel in the country instead of picking on a state that already has a good health care programme.

Similar claims were made by Telangana which rejected the scheme arguing that its Aarogyasri scheme covers 70 per cent of the state’s population, while the Ayushman Bharat will benefit a mere 80 lakh people.

The scheme, which calls for a 60:40 funding between centre and state, was termed as a hoax by the Kerala government. In an interview with The Indian Express, State Finance Minister Thomas Isaac has recently raised questions on the “feasibility” terming it an “obvious hoax”. In his interview, Isaac wondered how the government would implement the scheme at such a big scale. “The subsidy ceiling for the current RSBY scheme of Rs. 30,000 benefit is Rs. 1,250. The subsidy for the Ayushman scheme, with benefits of Rs. 5 lakh, is Rs. 1,110. Is it possible to have such a jump in benefits for lower premium?” he had said.

CM Arvind Kejriwal-led Delhi government has rejected to implement as it targets 6 lakh families, which is just 3 per cent of its 2-crore population.

Amarinder Singh’s led Punjab government also held similar reservations. Punjab had written to the centre saying it will sign the Memorandum of Understanding to operationalise the scheme only after it gets clarity on the flow of finances.[9]

Prime Minister Narendra Modi on September 23 launched the Pradhan Mantri Jan Arogya Yojana (PMJAY)-Ayushman Bharat and termed it a “game-changer initiative to serve the poor”.

However, the scheme, which aims to provide a coverage of Rs 5 lakh per family annually, will not cover five states — Delhi, Kerala, Odisha, Punjab and Telangana. These states have opted out of the scheme.[10]

Delhi is not among the states and union territories that have signed a Memorandum of Understanding (MoU) with the Centre to implement the healthcare programme.

Chief Minister and AamAadmi Party (AAP) National Convener Arvind Kejriwal has claimed the scheme is a public relations exercise which will prove to be another jumla (rhetoric).

On September 23, AAP termed the scheme “another white elephant in the making” and alleged that it covers only six lakh out of 50 lakh families in Delhi.

It further claimed that the ‘Delhi model’ of healthcare is better than the Centre’s PMJAY.[11]

Newly updated on 8th June 2019

The Centre and the Delhi government continue to be at loggerheads over the implementation of the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY), the Narendra Modi-led National Democratic Alliance (NDA) government’s flagship health scheme.

While newly appointed Union Minister of Health and Family Welfare Harsh Vardhan earlier this week urged four states, including Delhi, to implement the scheme, Delhi chief minister Arvind Kejriwal had said the national capital will not adopt the scheme. Kejriwal had claimed that the Delhi government’s health scheme was 10 times better than AB-PMJAY.

Arvind Kejriwal argued in his letter to the union health minister that AB-PMAJY was available to only those with incomes less than ₹10,000 per month when the minimum wage of a daily labourer in Delhi was higher than that. He also said that the existing scheme extended health benefits to all 2 crore citizens of the national capital.[12]

CRITICISM OF AYUSHMAN BHARAT YOJANA:

Currently, access to health services varies significantly across Indian states. At the national level, India only has 0.62 doctors for every 1,000 population, as opposed to the World Health Organization standard of 1 doctor per 1,000 population. However, at the state level, Karnataka, Tamil Nadu, Kerala, Punjab, Goa, and Delhi have more than 1 doctor for every 1,000 people. In fact, Tamil Nadu and Delhi have 1 doctor for every 253 and 334 persons respectively. Such a high density of doctors in these states puts them at par with countries such as Norway and Sweden in terms of access to healthcare. In comparison, Jharkhand, Haryana and Chhattisgarh have only 1 doctor for every 6,000 persons, which greatly reduces the accessibility of healthcare in these states.[13]

[1]http://ayushmanbharat.site/

[2]https://www.livemint.com/

[3]http://www.pib.gov.in

[4]https://www.businesstoday.in/current/economy-politics/ayushman-bharat-ceo-12-lakh-people-free-treatment-scheme/story/321287.html

[5]https://www.businesstoday.in/current/economy-politics/ayushman-bharat-scheme-averaged-5000-claims-per-day-in-first-100-days/story/306180.html

[6]https://www.business-standard.com/article/companies/crisil-sme-tracker-ayushman-bharat-a-blessing-for-sme-hospitals-119061000914_1.html

[7]https://www.pmjay.gov.in

[8]https://www.pmjay.gov.in

[9]https://www.financialexpress.com/india-news/these-5-states-rejected-pm-narendra-modis-ambitious-ayushman-bharat-scheme-here-is-the-list-and-why-they-did-so/1324939/

[10]https://www.moneycontrol.com/news/india/5-states-opted-out-of-ayushman-bharat-heres-why-2979691.html

[11]https://www.moneycontrol.com/news/india/5-states-opted-out-of-ayushman-bharat-heres-why-2979691.html

[12]https://www.livemint.com/

[13]https://www.livemint.com/Opinion/m8C6St66ulRHEgZ2ZBkcnN/Opinion–Ayushman-Bharat-a-critical-perspective.html