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Health benefit package under AB PM-JAY revised

Context:

The Health Benefit Package (HBP) Master under the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB PM-JAY) scheme has been revised.

Relevance:

GS-II: Social Justice and Governance (Issues related to Health, Welfare Schemes, Government Policies and Initiatives)

Dimensions of the Article:

  1. About Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY)
  2. Revised Health Benefit Package (HBP 2.2)
  3. About the National Health Authority (NHA)

About Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY)

  • Ayushman Bharat – Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) is a Centrally Sponsored Scheme having central sector component under Ayushman Bharat Mission anchored in the Ministry of Health and Family Welfare (MoHFW).
  • It is an umbrella of two major health initiatives, namely Health and wellness Centres and National  Health Protection Scheme.
  • The PM Jan Arogya Yojana beneficiaries get an e-card that can be used to avail services at an empanelled hospital, public or private, anywhere in the country, with which they can walk into a hospital and obtain cashless treatment.
  • The scheme has certain pre-conditions by which it picks who can avail of the health cover benefit. While in the rural areas the list is mostly categorized on lack of housing, meagre income and other deprivations, the urban list of PMJAY beneficiaries is drawn up on the basis of occupation.
  • AB PM-JAY is the flagship scheme of the Union government as a part of the Indian government’s National Health Policy.

National Health Protection Mission (AB-PMJAY)

  • AB-PMJAY provides a defined insurance benefit cover of Rs. 5 lakh per family per year. This cover will take care of almost all secondary care and most of tertiary care procedures.
  • To ensure that nobody is left out (especially women, children and elderly) there will be no cap on family size and age in the scheme.
  • The beneficiaries can avail benefits in both public and empanelled private facilities. All public hospitals in the States implementing AB-PMJAY, will be deemed empanelled for the Scheme.
  • Benefits of the scheme are portable across the country and a beneficiary covered under the scheme will be allowed to take cashless benefits from any public/private empanelled hospitals across the country.
  • To control costs, the payments for treatment will be done on package rate (to be defined by the Government in advance) basis.

Health and Wellness Centres (AB-PMJAY)

  • Under this 1.5 lakh existing sub centres will bring health care system closer to the homes of people in the form of Health and wellness centres.
  • These centres will provide comprehensive health care, including for non-communicable diseases and maternal and child health services.

Revised Health Benefit Package (HBP 2.2)

  • Rates of some packages have been increased by 20 per cent to 400 per cent under the PM-JAY. Regular rates of the packages were being revised to provide better healthcare services.
  • Rates of around 400 procedures have been revised and one new additional medical management package related to black fungus has also been added.
  • The rate revision has been done in the following categories:
    • radiation oncology procedures
    • Medical Management procedures like procedure for dengue, acute febrile illness etc
    • surgical package treatment for black fungus
    • other procedures like Right/left heart catheterization, PDA closure, Arthrodesis, Cholecystectomy, appendicectomy etc.
  • Under medical management procedures, rates for ICU with ventilator support have been revised by 100 per cent, rates for ICU without ventilator by 136 per cent.
  • New packages are added to cover more disease conditions.
  • HBP 2.2 packages for oncology will enhance cancer care for the beneficiaries in the country.
  • The rationalised HBP will further improve the uptake of schemes in private hospitals leading to reduced out-of-pocket expenditure for the beneficiaries.
  • Currently, Ayushman Bharat PM-JAY covers 1,669 treatment procedures out of which 1,080 are surgical, 588 medical and one unspecified package.

About the National Health Authority (NHA)

  • National Health Authority (NHA) is the apex body responsible for implementing India’s flagship public health insurance/assurance scheme called “Ayushman Bharat Pradhan Mantri Jan Arogya Yojana”.
  • The NHA been entrusted with the role of designing strategy, building technological infrastructure and implementation of “Ayushman Bharat Digital Mission” to create a National Digital Health Eco-system.
  • National Health Authority (2019) is the successor of the National Health Agency, which was functioning as a registered society since 2018 (Not a Statutory body).
  • NHA has been set-up to implement PM-JAY, as it is popularly known, at the national level.
  • NHA is an attached office of the Ministry of Health and Family Welfare with full functional autonomy.
  • NHA is also leading the implementation for Ayushman Bharat Digital Mission ABDM in coordination with different ministries/departments of the Government of India, State Governments, and private sector/civil society organizations.
  • NHA is governed by a Governing Board chaired by the Union Minister for Health and Family Welfare and it is headed by a Chief Executive Officer (CEO), an officer of the rank of Secretary to the Government of India, who manages its affairs.

-Source: The Hindu

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October 2022
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