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4 Years of Ayushman Bharat-Pradhan Mantri Jan Arogya Yojana (AB PM-JAY)

Posted on September 24, 2022 by admin1  2023

In News

  • Ayushman Bharat-Pradhan Mantri Jan Arogya Yojana (AB PM-JAY) completes four years.
    • Ayushman Bharat Digital Mission (ABDM) completes one year.

Pradhan Mantri Jan Arogya Yojna (PM-JAY)

  • About:
    • The scheme was launched in September 2018 and recommended by the National Health Policy 2017, to achieve the vision of Universal Health Coverage (UHC).
    • It is a Centrally Sponsored Scheme having a central sector component under Ayushman Bharat Mission
    • PM-JAY was earlier known as the National Health Protection Scheme (NHPS) before being rechristened. 
      • It subsumed the then-existing Rashtriya Swasthya Bima Yojana (RSBY) which had been launched in 2008. 
  • Key Features: 
    • It is the world’s largest health insurance/ assurance scheme fully financed by the government and the cost of implementation is shared between the Central and State Governments.
    • It provides a cover of Rs. 5 lakhs per family per year for secondary and tertiary care hospitalization across public and private empanelled hospitals in India.
    • It covers up to 3 days of pre-hospitalization and 15 days of post-hospitalization expenses such as diagnostics and medicines.
    • There is no restriction on the family size, age or gender.
      • The RSBY had a family cap of five members. 
    • All pre-existing conditions are covered from day one.
  • Eligibility: 
    • The households included are based on the deprivation and occupational criteria of Socio-Economic Caste Census 2011 (SECC 2011) for rural and urban areas respectively. 
      • The coverage mentioned under PM-JAY, therefore, also includes families that were covered in RSBY but are not present in the SECC 2011 database. 
  • Cover Under PM-JAY
    • The cover under the scheme includes all expenses incurred on the following components of the treatment.
      • Medical examination, treatment and consultation
      • Pre-hospitalization
      • Medicine and medical consumables
      • Non-intensive and intensive care services
      • Diagnostic and laboratory investigations
      • Medical implantation services (where necessary)
      • Accommodation benefits.
      • Food services
      • Complications arising during treatment
      • Post-hospitalization follow-up care up to 15 days
  • Aims and Objectives:
    • To accelerate health system preparedness for immediate responsiveness for early prevention, detection and management, with a focus on health infrastructure development including for Paediatric Care and with measurable outcomes.
  • Benefits: 
    • It provides cashless access to health care services for the beneficiary at the point of service, that is, the hospital.
    • It envisions to help mitigate catastrophic expenditure on medical treatment which pushes nearly 6 crore Indians into poverty each year.
  • Achievements: 
    • In the last three years, the AB PM-JAY scheme has achieved several milestones in achieving the target of Universal Health Coverage.
    • The scheme has widened its arm across 33 States/Union Territories bringing ease to the beneficiary’s life while availing the treatment. 
      • More than 2 crore treatments have been provided to the beneficiary under the scheme. 
      • More than 17 crore beneficiaries have been verified through the Beneficiary Identification System (BIS) and have been provided with Ayushman cards.
      • It has proved to be a boon for women.
        • Of the total number of beneficiaries who have got benefitted under the scheme, over half of them are women.
  • Issues:
    • PM-JAY paid for only 0.52 million COVID-19 hospitalisations across the country. 
      • the share is negligible keeping in mind that the scheme claims to cover 165 million beneficiaries across the country.
    • The government insurance schemes did not cover all the target groups and eligible individuals, even those enrolled under insurance schemes were forced to fight the pandemic on their own and cough up large amounts of money to avail themselves of treatment. 
    • Under PM-JAY, beneficiaries can go to only a list of empanelled private hospitals. This has remained a major problem, particularly in smaller towns and villages, where hospitals are few and far between. 
    • PM-JAY has left out certain communities. Thousands of sex workers in Pune’s Budhwar Peth zone, for example, fought a solitary battle against the pandemic. 

About Ayushman Bharat Digital Mission

  • The Ministry of Health and Family Welfare formulated the Ayushman Bharat Digital Mission with the aim to provide the necessary support for the integration of digital health infrastructure in the country.
  • This visionary initiative, stemming from the National Health Policy, 2017 intends to digitise healthcare in India.

  • ABDM Components:
    • Health ID:
      • It is important to standardise the process of identification of an individual across healthcare providers. 
      • It will be used to uniquely identify persons, authenticate them, and threading their health records (only with the informed consent of the patient) across multiple systems and stakeholders.
    • Healthcare Professionals Registry (HPR)
      • It is a comprehensive repository of all healthcare professionals involved in delivery of healthcare services across both modern and traditional systems of medicine. Enrolling in the Healthcare Professionals Registry will enable them to get connected to India’s digital health ecosystem.  
    • Health Facility Registry (HFR):
      • It is a comprehensive repository of health facilities of the country across different systems of medicine. It includes both public and private health facilities including hospitals, clinics, diagnostic laboratories and imaging centres, pharmacies, etc.
    • Personal Health Records (PHR):
      • It is an electronic application through which patients can maintain and manage their health information (and that of others for whom they are authorised) in a private, secure, and confidential environment. 
      • The citizens can get a longitudinal view of the personal health record by creating and linking the health ID with the visited health care facilities.
  • Aims and Objectives: 
    • It aims to develop the backbone necessary to support the integrated digital health infrastructure of the country. 
      • It will bridge the existing gap amongst different stakeholders of the Healthcare ecosystem through digital highways.
    • It aims to create a seamless online platform that will enable interoperability within the digital healthcare ecosystem. 
    • It aims to give impetus to open and interoperable standards in the digital health ecosystem. 
    • It aims to significantly improve the efficiency, effectiveness, and transparency of health service delivery overall. 
      • Patients will be able to securely store and access their medical records (such as prescriptions, diagnostic reports and discharge summaries), and share them with health care providers to ensure appropriate treatment and follow-up. 
    • It aims to provide choice to individuals to access both public and private health services, facilitate compliance with laid down guidelines and protocols, and ensure transparency in pricing of services and accountability for the health services being rendered.
  • Limitations/Concerns:
    • Digital Divide: This could lead to exclusion of digitally illiterate and unconnected remote, hilly and tribal areas. 
    • Data Breach/Privacy issues: The lack of a data protection bill could lead to the misuse of data by private firms.
    • Huge requirement of skilled labours: Need for skilled manpower in the digital domain versus the latest computer skills.
    • Inadequate Primary Health Care data: Lack of infrastructure and staff at primary level.
    • Issue of interoperability of systems built by different states & the central repositories.

Health Sector in India

  • Healthcare has become one of India’s largest sectors, both in terms of revenue and employment. 
  • The Indian healthcare sector is growing at a brisk pace due to its strengthening coverage, services and increasing expenditure by public as well private players.
  • India’s healthcare delivery system is categorised into two major components public and private. 
    • The government, i.e. public healthcare system, comprises limited secondary and tertiary care institutions in key cities and focuses on providing basic healthcare facilities in the form of primary healthcare centres (PHCs) in rural areas. 
    • The private sector provides a majority of secondary, tertiary, and quaternary care institutions with major concentration in metros and tier-I and tier-II cities.

Challenges in Health Sector

  • Lack of Infrastructure: India has been struggling with deficient infrastructure in the form of lack of well-equipped medical institutes and less-than-adequate human resources. 
  • Shortage of Manpower: Shortage of efficient and trained manpower and the situation remains worrisome in rural areas.
  • Adversely Affects the Poorest: 
    • The chronic under-funding of the healthcare sector affects the poorest. 
    • Bad infrastructure in public facilities, long queues at hospitals such as AIIMS, or issues with accessing the facility leads to even the poorest spending out of pocket and going even to unlicensed practitioners.
    • The share of the richest 20 percent of the population in total public sector subsidies is nearly 31 percent, almost three times the share of the poorest 20 percent of the population.
  • Huge Patient Load: Even prior to the outbreak of the Covid-19 pandemic, healthcare facilities had been feeling the strain due to unmanageable patient-load. 
  • Large Out-of-Pocket Expenditure: High out-of-pocket expenditure remains a stress factor. It is estimated that public funding accounts for only 22% of the expenses on healthcare in India. Most of the remaining 78% of private expenditure is out-of-pocket expense. 

Source: LM

 
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