What Is Ayushman Bharat Yojana ?

Ayushman Bharat Pradhan Mantri Jan Arogya Yojana aims to provide free access to healthcare for 50 crore people in the country. People using the program access their own primary care services from a family doctor. When anyone needs additional care, then PM-JAY provides free secondary health care for those needing specialist treatment and tertiary health care for those requiring hospitalization. The programme is part of the Indian government’s National Health Policy and is means-tested. It was launched in September 2018 by the Ministry of Health and Family Welfare who established the National Health Authority as an organization to administer the program. It is a centrally sponsored scheme and is jointly funded by both the federal government and the states. By offering services to 50 crore (500 million) people it is the world’s largest government sponsored healthcare program.

Features

• Providing health coverage for 10 crores households or 50 crores Indians.
• Providing a cover of ₹5 lakh (US$7,000) per family per year for medical treatment in empaneled hospitals, both public and private.
• Offering cashless payment and paperless recordkeeping through the hospital or doctor’s office.
• Using criteria from the Socio Economic and Caste Census 2011 to determine eligibility for benefits.
• No restriction on family size, age or gender; all previous medical conditions are covered under the scheme.
• It covers 3 days of pre-hospitalisation and 15 days of post-hospitalisation, including diagnostic care and expenses on medicines.
• The scheme is portable and a beneficiary can avail medical treatment at any PM-JAY empanelled hospital outside their state and anywhere in the country
• Providing access to free COVID-19 testing.

Challenges

• A major challenge of implementing a national health care scheme would be starting with infrastructure in need of development to be part of a modern national system.
• India still has some basic healthcare challenges including relatively few doctors, more cases of infectious disease, and a national budget with a comparatively low central government investment in health care.
• Some of the problems lay outside the Health Ministry such as urban development or transport.
• While many government hospitals have joined the program, many private corporate hospitals have not. The private hospitals report that they would be unable to offer their special services at the government low price, even with a government subsidy.
• The scheme has faced challenges in form of fraudulent bills. In response, National Health Authority has revoked empanelment of 171 hospitals and imposed a penalty of ₹4.6 crore (US$640,000). Another 390 hospitals have been issued show cause notice.
• There have been media reports of misuse of the Ayushman Bharat scheme by unscrupulous private hospitals through submission of fake medical bills. AB-PMJAY involves a robust information technology infrastructure overseeing transactions and locating suspicious surges across the country.
• Health Minister Harsh Vardhan has blacklisted hospitals and named them publicly for misconduct.

The government will need to join hands with homegrown startups for effective implementation of its flagship health insurance scheme Ayushman Bharat, or the Pradhan Mantri Jan Arogya Yojana (AB-PMJAY).

Need to invite Startups to display cutting-edge technology to support functioning of the National Health Authority (NHA), which is the executive agency of PMJAY. The startups will be offer solution for seven identified problems that the scheme is currently facing such as securing patients’ database, building health workforce capacity and reducing cost of operations. It is a unique, opportunity for startups to be a participant and stakeholder in supporting the implementation of AB-PMJAY, the largest government-funded health assurance scheme in the world, The government also believes that mainstreaming startups will boost private investment in the country’s health sector.