PRADHAN MANTRI JAN AAROGYA YOJANA



INTRODUCTION


The Pradhan Mantri Jan Arogya Yojana popularly known as the Ayushman Bharat Yojana is the world’s largest healthcare scheme guaranteeing health Insurance to the economically vulnerable classes in India .It was launched under the flagship of the Ministry of Health and Family Welfare on September 2018 as a part of the National Health policy and is administered by the National Health Authority which was specifically setup for this purpose. This social security scheme intends to cover medical expenses up to 5 lakh incurred by each of the eligible families annually and does not specify the time period privileged for. This world’s largest government sponsored program aims to cover 50 crore people that is almost 40% of India’s population.

This ‘ambitious scheme’ as quoted by Forbes India and WHO has been allocated 6,400 crores out of the 69,000 crore allotted by the Centre in its 2020 Union Budget.


FEATURES


It covers low income earning families up to 5 lakh per annum on expenses incurred both for secondary and tertiary care accessed in both private and public hospitals who will be reimbursed equally. It covers up to 3 days of pre hospitalization expenses and 15 days of post hospitalization, both ways covering medical and diagnostic expenses. The scheme covers up to 1393 medical procedures, and pays for almost everything beginning for outpatient charges, surgeon’s consultation, drugs, diagnostic services, room charges, ICU(ventilator not specified) and supplies. It does not put any gender, caste restrictions to access it. Another important feature is portability. The poor migrant workers can claim treatment outside their states.


This Scheme is optional for


ELIGIBILITY


The beneficiaries were selected from the Socio Economic census of 2011, which classifies people on the basis of 7 deprivation criteria ie, destitutes, Manual scavenging families, bonded laborers, primitive tribal groups, persons living on alms and any person satisfying any such one would be eligible under this scheme and can apply for Ayushman Bharat Yojana health card.


This scheme covers the both the urban and rural poor and has laid down separate criteria to identify the same.


· RURAL AREAS:


1)SC/ST

2) No abled adult member/man between 16-59

3)Household with only 1 room with kucha walls and roof

4) A Disabled member in the household etc.


· URBAN AREAS

1) Beggar

2) Domestic worker

3) Rag picker

4) Cobbler/Street Vendor/Hawker/Other service providers on the street.

5) Plumber/Construction Worker/Mason/Painter/Labour/Welder/Security Guard/Coolie

6) Sweeper/Mali/Sanitation Worker

7) Artisan/Handicrafts Worker/Tailor/Home-based Worker

8) Driver/Transport Worker/Conductor/Cart or Rickshaw Pullers/Helper to Drivers or Conductors

9)Shop Workers/Peon in Small Establishment/Assistant/Helper/Attendant/Delivery Assistant/Waiter

10) Mechanic/Electrician/Repair Worker/Assembler

11) Chowkidar /Washer-man[1]


NON-ELIGIBILITY


1) Those who own a two, three or four-wheeler or a motorised fishing boat

2) Those who own mechanised farming equipment

3) Those who have Kisan cards with a credit limit of Rs.50000

4) Those employed by the government

5) Those who work in government-managed non-agricultural enterprises

6) Those earning a monthly income above Rs.10000

7) Those owning refrigerators and landlines

8) Those with decent, solidly built houses

9) Those owning 5 acres or more of agricultural land


MEDICAL PACKAGES


As a beneficiary of the scheme, families, as well as individuals, can avail nearly 25 specialities, which include:

· Cardiology

· Oncology

· Neurology

· Paediatrics

· Orthopaedics

· COVID-19


CRITICAL ILLNESS/DISEASE COVERED UNDER THE SCHEME


· Prostate cancer.

· Double valve replacement.

· Coronary artery bypass graft.

· COVID-19.

· Pulmonary valve replacement.

· Skull base surgery.

· Anterior spine fixation.

· Laryngopharyngectomy with gastric pull-up

· Tissue expander for disfigurement following burns.

· Carotid angioplasty with stent.

IMPACT AND CHALLENGES:


As per the Union Health Minister Harsh Vardhan report on 23rd September 2019, 47 lakh people had received benefits worth 7,500 crore in the past 1 year and 60% of that amount was used for tertiary care. Ten Crore e-cards were generated and 18,000 hospitals were empaneled under the scheme. Out of the total hospitals empaneled 53% were private multi speciality hospitals.

The whitepaper titled ‘National Health Protection Scheme: Ayushman Bharat – Growing Opportunities in Affordable Healthcare’ has examined the impact of Ayushman Bharat.It says that the Medical Devices industry in the country is likely to triple. The report says that since its inception the NPHS has covered about 100 million families and has offered an insurance coverage of USD 7000 per family. The most interesting part is that it covers almost 1,350 procedures used for both critical and non-critical patients. It also pointed out that the Healthcare industry would largely expand as due to increased catering of services to the poor the hospitals are likely to find a large influx of patients. This is likely to result in an increased demand for Medical equipments and associated devices due to an increase in the number of patients demanding secondary and tertiary care. So as result the compound annual growth rate of the medical devices industry is likely to spike upto 30-35%.Though the demand for medicines too could rise up but is expected not to be in proportion with the medical devices industry.

Another major challenge faced is corruption. As per a news report 171 hospitals were revoked empanelment and were penalized up to 4.6 crores for showing fake bills and demanding reimbursement. Another 390 hospitals were given a show cause notice.

In addition may private hospitals refuse to join pointing out their inability to offer services at government subsidized rates. The number of qualified doctors don’t match the number of hospitals ratio hence furthering the issues.

Overall it is difficult to evaluate the effectiveness of this scheme as the exact number of beneficiaries is unavailable in the public domain. Hence assessing where the 6,400 crores would go is a challenge as any other social security scheme and is not devoid of any foul play.



REFERENCES


1. https://www.acko.com/health-insurance/ayushman-bharat-yojana-scheme/

2. https://www.bajajfinserv.in/insights/ayushman-bharat-yojana-are-you-eligible-for-the-pmjay-scheme

3. https://www.financialexpress.com/industry/impact-of-ayushman-bharat-scheme-medical-devices-equipment-to-earn-usd-2-billion-sector-to-make-a-killing-in-three-years-skps-whitepaper/1708980/#:~:text=Ayushman%20Bharat%20impact%20on%20the%20healthcare%20industry&text=The%20international%20consulting%20firm%20further,across%20Medical%20Equipment%20and%20Furniture. [1] https://www.acko.com/health-insurance/ayushman-bharat-yojana-scheme/


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