Can we hope for a healthier India with the Ayushman Bharat scheme?

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Can we hope for a healthier India with the Ayushman Bharat scheme?

The National Health Policy introduced Ayushman Bharat in 2018, a flagship program of the Indian government, aiming to achieve the goal of Universal Health Coverage (UHC). This program was created to fulfill the Sustainable Development Goals (SDGs) and their core principle, "leave no one behind."

Ayushman Bharat was developed in an effort to move away from a sectoral approach towards a comprehensive need-based approach. This program aims to address the healthcare system holistically, including ambulatory care, promotion, and prevention at the primary, secondary, and tertiary levels.

Ayushman Bharat uses a care strategy that consists of two interconnected parts, namely -

• Health and Wellness Centres (HWCs)

• Pradhan Mantri Jan Arogya Yojana (PM-JAY):

PMJAY is one of the biggest health insurance programs in the world. With coverage for diagnostic tests, pre-hospitalization costs, and medical treatment costs, it offers a cover of Rs 5 lakhs per family per year. Additionally, PMJAY offers a paperless facility and a cashless health insurance feature.

Over 10.74 crore low-income families, or roughly 40% of all families in India, are covered by PMJAY.

Ayushman bharat scheme eligibility check:

The eligibility criteria are distinct for the rural and urban population. Let’s roughly state both.

Rural population:

Families without an adult or a male adult member between 16 and 59 years of age, SC/ST, living in temporary shelters, tribals, etc

Urban population:

Domestic workers, street vendors, watchmen, laborers, construction workers, artisans in small-scale industries, beggars, rag-pickers, etc.

What are the advantages of the PMJAY program?

• The PMJAY program covers pre-hospitalization expenses for up to three days and post-hospitalization expenses for up to fifteen days, including the cost of diagnostics and medications.

• There are no limitations based on family size, age, or gender.

• Pre-existing conditions are covered.

• Daycare expenses

• Those enrolled in the program have access to paperless health insurance and other services.

• Nationwide access is available to the facilities covered by PMJAY.

COVID’19: Was the Ayushman Bharat scheme a saviour?

The scheme aimed to curb the out-of-pocket expenditure of the poor and downtrodden, but showed poor performance. The pandemic exposed the flaws in our healthcare system and the fact that implementation of small-scale solutions (like health insurance programs) won't have much of an impact in the long run. Poor implementation of policies, improper execution and corruption are to be blamed.

• Many states had their own health programs, which collectively covered a lot more people than Ayushman Bharat intended to.

• The scheme collaborated with the German GIZ as a consultant despite the company’s poor reputation.

• The available data supporting the eligibility criteria is old. A number of beneficiaries are ineligible at present as per the out-dated criteria. The government is trying to cut down on the number of beneficiaries due to a lack of funds.

• The government appointed Third Party Administrators lack transparency in their functioning. With over 13,000 hospitals empanelled under the scheme and cash incentives to the doctors, it is disappointing to see the shoddy state of affairs.

Current developments in the scheme:

The Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB PM-JAY), the National Health Authority's (NHA) flagship program, has released a newly updated and dynamic public dashboard.

From a state/UT perspective, it offers a transparent view of the scheme's development. It has a user-friendly interactive interface that presents the scheme's key performance indicators through instructive charts. It aims to give the general public and stakeholders an insight into the scheme’s performance. The dashboard now includes information on the most popular procedures and specialties used by beneficiaries in hospitals that are enrolled in the program.

In a nutshell, we can say that the human resources are what make this program successful. Empathy, honesty, and a vigilant monitoring system in the scheme can help build a healthier India.