India has attained consequential public health achievements and witnessed advancements in healthcare services during the last thirty years. The health industry of India is counted amongst the fastest growing industries, likely to arrive at $280 billion by 2020.
Even after achieving so much in the health sector, this sector still has immense loopholes requiring immediate attention. It is still typified by high medical expenditure, mediocre health insurance, and less financial protection to both urban and rural population. It is a grave situation that 62.58 percent people have to bear huge out-of-pocket medical expenses and are out of the scope of any health protection schemes. To avail the basic health facilities, they have to either sell their assets or take loans which push 4.6 percent of the population below the poverty line.
The Government of India conceived an ambitious medical scheme, ‘Ayushman Bharat Yojana-National Health Protection Scheme’ to ensure complete and efficient healthcare services to its people. The scheme will cut down the financial strain on the poor and sensitive groups, improvise the current conditions of the poor, and provide them with good medical facilities in the form of health insurance. The scheme was announced on the auspicious occasion of Independence Day by Prime Minister Narendra Modi and will be launched on September 25, 2018. The scheme is also called ‘Pradhan Mantri Jan Arogya Abhiyaan’ and is dubbed as ‘Modicare’.
What is Ayushman Bharat -National Health Protection Mission?
Ayushman Bharat Yojana is an endeavor by the Indian government to shift from sectoral and fractional delivery of health care services to all-inclusive healthcare services. It is a National Health Protection Scheme which will provide health insurance coverage worth Rs. 5 lakh to each of the selected 10 crore poor families (called beneficiaries) every year for secondary and tertiary care hospitalization. There are about 1,354 medical packages included in the scheme by the health ministry. These packages include surgical procedures and medical treatments involving expenses relating to medicines, transport, and diagnostics. The scheme is an amalgamation of the two central government schemes – Senior Citizen Health Insurance Scheme (SCHIS) and Rashtriya Swasthya Bima Yojana (RSBY).
AB-NHPM is a widespread initiative which will help in building a New India 2022. The implementation of this scheme will be carried out at an exceptional scale and will bring a paradigm transformation in the health sector of India.
Objectives of Ayushman Bharat -National Health Protection Mission (AB-NHPM)
Ayushman Bharat Yojana, a National Health Protection Scheme, has 2 main objectives to fulfill –
1. Setting up of health and wellness centers all over India to provide extensive primary medical services to the poor, vulnerable families.
2. Granting health insurance coverage to about 40 percent of the population deprived of basic healthcare services.
Components of Ayushman Bharat – National Health Protection Mission (AB-NHPM)
1. Setting up of 1.5 lakh ‘Health and Wellness Centres’ all over the country in order to bring basic healthcare facilities within the reach of the people. These centers will provide Comprehensive Primary Health Care (CPHC) which include child care, maternal care, treating of non-communicable diseases, free medications, and diagnostic facilities. Prime Minister Narendra Modi launched the first health and wellness center on April 14 this year in Bijapur.
2. National Health Protection Mission (NHPM) is a health insurance coverage to be given to poor and deprived families. The above-mentioned health and wellness centers will help in spreading the awareness about the Ayushman Bharat.
Important features of Ayushman Bharat – National Health Protection Mission (AB-NHPM)
- The scheme will provide a health insurance cover of Rs. 5 lakh to each family every year.
- The medical benefits to be given under this scheme will be based on the deprivation norms in the SECC database.
- The scheme is applicable all over the country and its beneficiaries can have cashless health benefits from any public or private empanelled hospitals in India.
- The payment rates for the treatment of the beneficiaries will be decided by the government in advance in order to control the costs.
- The central principle of AB-NHPM is to promote co-operative federalism and adaptability to the states.
- The members of the eligible families are required to carry Aadhar card or other IDs prescribed by the government to avail the benefits of this scheme at the empanelled hospitals.
- Ayushman Bharat National Health Protection Mission Council (AB-NHPMC) will be set up at the apogee to formulate policies and foster coordination between the center and the states. The council will be led by the Union Health and Family Welfare Minister.
- The states implementing the scheme will have a State Health Agency (SHA).
- The funds for the implementation of the scheme will be directly transferred by the Central Government to the State Health Agencies by way of an escrow account on a timely basis.
- The central government will create a strong, modular, and extensible IT platform in association with NITI Aayog to assist in paperless, cashless transactions.
Core benefits of Ayushman Bharat – National Health Protection Mission (AB-NHPM)
Benefits to beneficiaries
- Health cover of Rs. 5 lakhs to each family for secondary and tertiary care procedures.
- No restriction on the size of the family, the age of the beneficiaries, or their gender.
- Priority is given to girl child, women, and senior citizens.
- All the members of the eligible families present in the database of SECC are necessarily covered.
- The medical treatment given to the eligible families is free of cost.
- Empanelled hospitals cannot ask for extra money for the treatment from the beneficiaries.
- Paperless and cashless availability of health care services to the beneficiaries.
- Good amount of medical packages available to the beneficiaries which include surgery, medicine and diagnostics cost, and other treatments.
- Eligible candidates can avail the services of this scheme all over India
Benefits to the health system
- The scheme ensures the availability of good quality secondary and tertiary care services through empanelled private and public hospitals to the members of the poor and vulnerable families free of cost.
- It improves the health of the citizens of India, thereby strengthening the health sector of India.
- Aligns the development of the private sector with the public sector health goals.
- Improved patient satisfaction
- Helps in the setting up of fresh health framework in the rural and remote areas.
- Enhances the quality of life of the poor and deprived population.
- The scheme improves the efficiency and productivity of the population.
Implementation strategy of Ayushman Bharat – National Health Protection Mission (AB-NHPM)
At national Level: Ayushman Bharat-National Health Protection Mission Agency (AB-NHPMA) will be set up to manage the scheme at the national level.
At the state level: State Health Agency (SHA) in every state shall be created to implement the scheme in the states and union territories. The SHA can either be a Society/State Nodal Agency (SNA)/Trust/Non-profit company or a new entity. The states or union territories can implement this Ayushman Bharat scheme through insurance companies, society, or trust. The funds to be used in this scheme will be transferred by the government through an escrow account.
National Health Agency (NHA)
The National Health Agency (NHA) is a self-governing entity established on May 11, 2018, to effectively implement AB-NHPM all over India. The agency is registered as a society under the Society Registration Act, 1860. It will help in the formulation of the scheme’s policies and guidelines, its management and implementation, rolling out of the scheme, coordinating with the state governments, and supervising and maintaining of AB-NHPM across the country. The agency will also work as a link between the central and the state governments, the scholarly world, civil society, insurance and financial agencies, national and foreign organizations and other collaborators.
Availability of Ayushman Bharat – National Health Protection Mission (AB-NHPM)
At present, Ayushman Bharat scheme will be implemented in 22 states on the basis of “trust model”. The states-Punjab, Mumbai, Kerala, Delhi, and Karnataka – are still to come on board. Odisha has declined the idea of applying this scheme in the state.
Number of beneficiaries of Ayushman Bharat – National Health Protection Mission (AB-NHPM)
Ayushman Bharat – National Health Protection Mission is aiming to benefit about 10.74 crore poor and vulnerable families identified on the basis of the data of Socio-Economic Caste Census (SECC). These families will be from both the rural as well as urban areas.
Who will bear the expenses for Ayushman Bharat – National Health Protection Mission (AB-NHPM)?
The beneficiaries of this scheme are not required to pay anything from their pockets. Since this is a medical insurance scheme, all the expenses relating to payment of premium will be borne by the government. It will be shared by the Central and the State governments in a specified ratio prescribed by the Ministry of Finance.
If the scheme is availed through insurance companies: The expenditure to be incurred by the Central and the State governments is dependent on the real-time premium rates prevailing in the markets of the State and the Union Territories where the scheme will be applicable.
If the scheme is availed through Trust/Society: The expenditure by the Central government will be based on either the actual expenditure or the amount of maximum premium, whichever is less, in a fixed ratio.
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