Key Progress and Insights from the Ayushman Bharat Scheme

Context:

Beneficiaries aged 70 years and above made up over 12 per cent of all admissions under the government’s flagship Ayushman Bharat health insurance scheme, according to data presented in Parliament by the Union Ministry of Health and Family Welfare.

Relevance:

Focus:  GS II-  Issues relating to development and management of Social Sector/Services relating to Health, Education, Human Resources.

Dimensions of the Article:

1. Key Progress and Insights from the Ayushman Bharat Scheme
2. Elderly Care Focus in Ayushman Bharat
3. About Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY)
4. About the National Health Authority (NHA)

Key Progress and Insights from the Ayushman Bharat Scheme

• As of January 2024, the Ayushman Bharat scheme successfully issued over 30 crore Ayushman cards, with a notable app launch aimed at streamlining the card creation process.
• Uttar Pradesh leads with 4.83 crore cards, followed by Madhya Pradesh and Maharashtra with 3.78 crore and 2.39 crore cards, respectively.
• Notably, 48% of the treatments under this scheme have been utilized by women, showcasing the scheme’s commitment to gender equity.
• The scheme has facilitated over 6.2 crore hospital admissions, translating into more than Rs. 79,000 crores in medical treatments.

Elderly Care Focus in Ayushman Bharat

• Senior Citizen Coverage: Elderly beneficiaries (aged 70 and above) represent over 12% of all admissions and nearly 14% of the total expenditure, reflecting the scheme’s targeted support towards aging populations.
• Government Expansion Plans: There are plans to extend benefits to all individuals over 70, potentially adding nearly 4 crore new beneficiaries, regardless of their economic status.
• State Expenditure on Elderly: States like Maharashtra, Kerala, and Haryana are among those with the highest expenditure on elderly care, indicating a focused allocation of resources towards aging populations.
• Policy Utilization and Costs: The inclusion of ASHA and Anganwadi workers in February’s interim budget, with a slight budget increase in July, aims to broaden the scheme’s reach and impact, particularly among India’s growing elderly population projected to reach 319 million by 2050.

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.

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.