World’s Largest Government Funded Healthcare Program
The Prime Minister Shri Narendra Modi announced the inauguration of the Ayushman Bharat-Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) on September 23, 2018 in Ranchi, Jharkhand.
With the introduction of Ayushman Bharat - Pradhan Mantri Jan Arogya Yojana (AB-PMJAY), India makes a significant step toward providing the general public with accessible and cheap healthcare. Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) shall be executed in accordance with the Ayushman Bharat vision to ensure that each and every citizen receives his or her fair share of healthcare. The government has elevated healthcare protection with the Ayushman Bharat - Pradhan Mantri Jan Aarogya Yojana. With more than 50 crore beneficiaries, this is the "biggest government-funded healthcare programme" in the world.
Benefits of The Scheme:
• For secondary and tertiary care hospitalization, the Ayushman Bharat- Pradhan Mantri Jan Arogya Yojana (PMJAY) will offer a cover of up to Rs. 5 lakhs per family per year.
• These benefits will be available to around 10.74 crore vulnerable entitled families, or roughly 50 crore people.
• At the moment of service, PMJAY will offer the beneficiary cashless and paperless access to services.
• PMJAY will assist to lessen the financial risk associated with catastrophic health crises by lowering hospitalization costs that cause people to become impoverished.
• Families that qualify will be able to access the high-quality medical care they require without experiencing hardship.
• When completely completed, PMJAY will rank as the largest fully-financed health protection programme in the world. It is a bold move that will help the cause of universal health coverage advance (UHC).
• Through the use of Health and Wellness Centers (HWCs) at the primary level and the provision of financial protection for accessing curative care at the secondary and tertiary levels through engagement with both public and private sector, Ayushman Bharat advances the promotive, preventive, curative, palliative, and rehabilitative aspects of Universal Healthcare.
• It uses a continuum of care strategy with two interconnected parts: The establishment of 1, 50,000 Health and Wellness Centers will bring healthcare closer to people's homes.
• These facilities will offer Comprehensive Primary Health Care (CPHC), which includes free basic medications and diagnostic services and addresses non-communicable illnesses, maternity and child health care, and both.
• On April 14, 2018, the Prime Minister opened the first Health and Wellness Center in Jangla, Bijapur, Chhatisgarh.
• The second element is the Pradhan Mantri Jan Arogya Yojana (PMJAY), which offers secondary and tertiary health protection coverage to low-income and vulnerable households.
• The Health and Wellness Centers will be crucial in raising awareness of PMJAY, screening for non-communicable diseases, and following up with patients who have been hospitalized, among other things.
• According to data from the 71st round of the National Sample Survey Organization (NSSO), 82% of urban households and 85.9% of rural households do not have access to health insurance or guarantee. More than 17% of Indians devote at least 10% of their family budgets on medical expenses.
• Families are forced into debt by catastrophic healthcare costs, in rural India, more than 24% of households and 18% of urban residents have borrowed money to cover these costs.
• In accordance with the most recent Socio-Economic Caste Census (SECC) data for both rural and urban areas, as well as the active families covered by the Rashtriya Swasthya Bima Yojana (RSBY), PMJAY primarily targets the poor, deprived rural families and identified occupational category of urban workers' families.
• The benefits will be available to about 10.74 crore identifiable families (or over 50 crore beneficiaries). There are no restrictions on pre-existing ailments, family size, or age.
• The Yojana aims to lower out-of-pocket hospitalization costs, meet unmet needs, and improve designated families' access to high-quality inpatient care and day surgery.
• Through a network of Empanelled Health Care Providers, the Yojana would offer coverage for secondary and tertiary care hospitalization up to Rs. 5, 00,000 per family per year (EHCP).
• The beneficiaries of the EHCP network would have paperless and cashless access to services at both public and private hospitals.
• 1350 procedures totaling pre- and post-hospitalization, diagnostics, medications, and other services will be provided.
• Through the provider network, the Yojana beneficiaries would be able to move freely across borders and receive services all around the nation.
Alliance With States:
• Through national conclaves, sectoral working groups, extensive field exercises, and the piloting of key modules, stakeholders' input from all States and UTs was included into the scheme architecture and formulated in a truly federal approach.
• The Scheme is built on principles rather than rules, giving States enough latitude in terms of packages, practices, scheme architecture, entitlements, and other parameters while guaranteeing that the fundamental advantages of portability and fraud detection are guaranteed at the national level.
• States are free to choose the implementation modalities and may employ an existing Trust or Society or create a new Trust or Society to carry out the Scheme as their State Health Agency.
• States can use a mixed strategy to implement the Scheme, either directly through the Trust/Society/Implementation Support Agency or through an insurance business.
Advancement of The Plan:
MOUs with the states: The mission's implementation has already begun thanks to the signatures of 30 states and UTs on the MoU. Maharashtra joined on August 14, 2018. The MoU with Tamil Nadu was signed on September 11th, 2018.
PMJAY'S Test Launch:
• The plan's pilot launch has begun. The mission's prototype launch will test and improve the developed IT systems with the goal of streamlining state preparation for a full launch.
• The pilot was conducted in about 22 States and/or UTs (Arunachal Pradesh, Chandigarh, Chhattisgarh, Dadar Nagar & Haveli, Daman & Diu, Haryana, Himachal Pradesh, Madhya Pradesh, Manipur, Meghalaya, Mizoram, Nagaland, Uttarakhand, West Bengal, Uttar Pradesh, Jammu & Kashmir, Goa, and Maharashtra among others).
• To test the Beneficiary Identification System (BIS) and Transaction Management System (TMS) systems, a pilot launch is being conducted at a few hospitals.
• Over 1280 hospitals are participating in the test launch.
Pradhan Mantri Aarogya Mitra (Pmam):
• The programme is developing a group of qualified frontline healthcare workers known as Pradhan Mantri Aarogya Mitras (PMAMs), who will serve as the main point of contact for beneficiaries seeking hospital care and thus serve as a support system for streamlining health service delivery.
• On August 27, 2018, in New Delhi, a MoU was signed by the National Health Agency and the Ministry of Skills Development & Entrepreneurship (MSDE).
• To improve operational readiness and implementation, Aarogya Mitras training is being delivered in partnership with the National Skill Development Corporation (NSDC) and Ministry of Skill Development.
• AarogyaMitras have been trained thus far in over 3519 different locations across 20 different states. In 27 states, training sessions for State, District, and PMAMs have been held.
• Around 3936 individuals have received training at the state, district, and PMAM levels.
Empanelment In A Hospital:
15,686 hospital empanelment applications have been submitted thus far.
Data Security And Fraud Prevention:
• To address the concerns of potential fraudulent activities that could be done by any person or organization, thorough rules have been developed.
• At the national and state levels, anti-fraud cells will be set up, and effective IT tools will be used to both prevent and identify fraud.
• When drafting these policies, references were made to international standards and regulations like ISO 27001, NIST, HIPAA, and the General Data Protection Regulation (GDPR), as well as Indian regulations like the Aadhaar Act 2016 and the Indian IT Act 2000, IT (amendment) Act, 2008, and the Personal Data Protection Bill by former judge BN Sri Krishnan (yet to be enacted).
It System Update:
• To identify and validate beneficiaries at CSCs and points of care, the Beneficiary Identification System (BIS) was established.
• The programme was evaluated by NHA in 80 districts spread over 10 states, and the system was improved based on user feedback.
• Since its launch on July 4th, the hospital empanelment module has received requests for empanelment from approximately 7,857 hospitals spread over 354 districts in 22 States and UTs.
• An exhaustive Hospital transactions are made easier by the Transaction Management System (TMS), which has been designed (such as filing pre-authorization requests and claims submission).
• To improve state preparation and get input on the IT systems, there have been trainings about the operability of IT systems all around the state.
• To teach state level authorities in using the created IT systems, targeted workshops have been arranged.
• To guarantee the confidentiality and privacy of the data, the IT platform is being equipped with strong security measures.
• A memorandum of understanding (MoU) has been inked with the Common Service Centre (CSC) for Beneficiary Identification, which will make use of the approximately 3 lakh village-level entrepreneurs.
• Sending personalized letters to the families listed in the Additional Data Collection Data (ADCD) effort is already underway. Each letter includes a unique family code. This will increase beneficiary knowledge and make the identification process easier when they visit CSC centers or places of care.
• Pradhan Mantri Ayushman Bharat Jan AarogyaYojana (AB-PMJAY) is a paradigm shift in the delivery of secondary and tertiary care from a sectorial, segmented, and fragmented approach through several national and State schemes to a larger, more comprehensive, and more convergent and need-based service delivery.