Achieving Universal Health Coverage via “Ayushman Bharat Yojana”

 

Ayushman Bharat Yojana also known as Pradhan Mantri Jan Arogya Yojana(PM-JAY) is one of the significant plans run in the whole world. It intends to cover 50 crore Indians. Only 10 crore families are covered until now. Among these 8 crore families from rural are and 2.23 crore families from urban areas. The scheme was started by keeping in mind the poor and unprotected class of society, as they have to pay a hefty amount for good quality medical help. “Leave no one behind.” is its bearing assurance

 

Ayushman Bharat is a way of transferring from segmented health service delivery to a comprehensive need-based health care service. The project plans to address the healthcare arrangement at primary, secondary, and tertiary levels. The scheme adopts the method of using 2 interrelated components Health and Wellness Centres (HWCs) and, Pradhan Mantri Jan Arogya Yojana (PM-JAY).

 

1. Health and Wellness Centers (HWCs)

1,50,000 primary healthcare centers and sub-centers would be turned in to Health and Wellness Centers (HWCs), said the Government of India. The aforementioned healthcare centers would be changed in Comprehensive Primary Health Care (CPHC). Services related to maternity and child, non-communicable diseases would be covered under this scheme. To make communities and individuals more aware of chronic diseases and to choose a healthy lifestyle are also an aim of this scheme. Essential drugs would be provided free of cost.

 

2. Pradhan Mantri Jan Arogya Yojana (PM-JAY)

 

PM-JAY is completely financed by government insurance, which is one of the largest fully covered insurance. PM-JAY e-card is important for taking benefit of the scheme. Secondary and tertiary level treatment is included in this scheme with Rs. 5 lakhs per family per year, whether the hospital is government or private. This scheme also covers COVID-19 treatment.

 

Features

1. Cashless hospitalization.
2. Includes up to 3 days of pre-hospitalization costs so as drugs and diagnostics.
3. Up to 15-days post-hospitalization is covered which includes drugs and diagnostics.
4. Every person whether from any family size, gender, or age is covered.
5. Services can be used at any hospital irrespective of its authority.
6. Pre-existing diseases are covered in this scheme from day 1 itself.
7. Medical treatments i.e. 1,393 different types are covered.
8. Includes charges for diagnostic services, drugs, room charges, physician’s fees, surgeon charges, supplies, ICU, and OT charges.
9. Government hospitals are paid the same as a private hospitals.

 

Problems

 

1. Huge demand for health care service– India ranked as 2nd largest populated country with 1.3 billion of population. Among this 19% population is 60+, which leads to more demands.

 

2. Catastrophic health out-of-pocket expenditure- Larger than 10% of the total expenditure of people, which constitutes 17.3% of the population, are spent on health expenditure.

 

3. 3. Changing disease profile- Non-communicable diseases have lead to the premature death of almost 23% of people.

 

4. Health Indices- Infant mortality rate of India has decreased from 42% in 2012 to 33% in 2015. India’s life expectancy has increased up to 69-years in 2021.

 

5. Health care infrastructure & workforce- For 1000 people there is only 1 bed. This is the most inferior in developing countries. India has 0.7 physicians per 10,000 population.

 

6. The disparity of health status in India- Kerala scored at 74.01 and Uttar Pradesh with 28.61 scores, making them the highest and lowest rank states in healthcare system performance. In smaller states, 38.51 in Nagaland & 74.97 in Mizoram. While in Ut 41.66 in Daman and Diu & 63.62 in Chandigarh.

 

The other challenges include-It comprises of reducing the cost of diagnosis, developing a technological solution to keep track of healthcare systems, increasing awareness, reducing chances of infection in the hospital, etc.

 

Recommendation

 

1. The PM-JAY Anti-Fraud – Guidelines for Anti-Fraud were released in 2018 to prevent, stop any misbehaviors. Every year around 6% of healthcare fraud takes place.

 

2. IT infrastructure- Data created with the help of IT can help us study different diseases and their patterns. This information can be used to make changes in the scheme and make it more beneficial.

 

3. Make in India-Ayushman Bharat guaranteed market can be beneficial for manufactures who are building different types of equipment in India. They can offer this equipment at a better price. Thus can stop the import of medical equipment.
4. Different start-ups and companies with innovative concepts should be encouraged to give opinions on how to efficiently make healthcare systems more sustainable.