BlogUnderstanding Ayushman Bharat 2023: India's National Health Protection Scheme

Understanding Ayushman Bharat 2023: India’s National Health Protection Scheme

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Ayushman Bharat 2023: Healthcare is one of the most important aspects of a country’s development. In India, healthcare has been a major concern for a long time due to the lack of accessibility and affordability. To address this issue, the Government of India launched Ayushman Bharat – Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) in 2018. This national health protection scheme aims to provide financial protection to over 100 million families, making it the world’s largest government-funded healthcare program. In this article, we will delve into the details of Ayushman Bharat and its impact on the Indian healthcare system.

What is Ayushman Bharat?

Ayushman Bharat – Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) is a government-funded health insurance scheme that aims to provide financial protection to poor and vulnerable families in India. The scheme provides cashless and paperless access to secondary and tertiary healthcare services to the eligible beneficiaries. Ayushman Bharat was launched on 23rd September 2018 by Prime Minister Narendra Modi.

Objectives of Ayushman Bharat

The main objectives of Ayushman Bharat are as follows:

  • To provide financial protection to poor and vulnerable families in India.
  • To reduce the out-of-pocket expenses for hospitalization and other medical services.
  • To increase access to quality healthcare services, especially in rural areas.
  • To create a robust healthcare system in India.
  • To reduce the burden of catastrophic health expenditures on families.

Benefits of Ayushman Bharat

Ayushman Bharat provides the following benefits to the eligible beneficiaries:

  • Cashless and paperless access to secondary and tertiary healthcare services.
  • Coverage of up to Rs. 5 lakhs per family per year for medical expenses.
  • Coverage for pre-existing diseases.
  • No limit on family size or age of the family members.
  • Transportation allowance for beneficiaries who need to travel for treatment.
  • Free and cashless treatment in any empanelled hospital across India.
  • Provision for follow-up care after hospitalization.

Eligibility criteria for Ayushman Bharat

The eligibility criteria for Ayushman Bharat are as follows:

  • The scheme is applicable to families listed in the Socio-Economic Caste Census (SECC) 2011.
  • The scheme is also applicable to families identified by the state government as eligible under Rashtriya Swasthya Bima Yojana (RSBY).
  • The beneficiary families should not have their own house or any four-wheeler.
  • The beneficiary families should not have any member who is a government employee or pays income tax.
  • The beneficiary families should not have any member who owns more than two hectares of agricultural land.

Coverage of Ayushman Bharat

Ayushman Bharat covers the following services:

  • Medical and surgical procedures.
  • Medical consultation and diagnostic tests.
  • Drugs and consumables.
  • Pre-hospitalization and post-hospitalization expenses.
  • Non-intensive and intensive care services.
  • Accommodation and food for patients.
  • Follow-up care after hospitalization

Implementation of Ayushman Bharat

The implementation of Ayushman Bharat is carried out by the National Health Authority (NHA) and State Health Agencies (SHAs). The NHA is responsible for the policy formulation, implementation, and monitoring of the scheme at the national level. The SHAs are responsible for the implementation of the scheme at the state level.

Under Ayushman Bharat, empanelled hospitals are required to follow certain guidelines and protocols to ensure quality healthcare services. The scheme also incorporates the use of technology for the verification of beneficiaries and for the monitoring of healthcare services.

Role of private sector in Ayushman Bharat

The private sector plays a crucial role in the implementation of Ayushman Bharat. Private hospitals can be empanelled under the scheme if they meet certain eligibility criteria. Empanelled private hospitals are required to provide cashless and paperless treatment to the eligible beneficiaries.

The private sector also plays a role in the provision of diagnostic services and medical equipment. Private diagnostic centres and medical equipment suppliers can also be empanelled under the scheme.

Ayushman Bharat and digital health

Ayushman Bharat incorporates the use of technology for the verification of beneficiaries and for the monitoring of healthcare services. The scheme also aims to promote digital health by encouraging the use of telemedicine and electronic health records (EHRs).

Telemedicine enables the remote delivery of healthcare services through the use of technology. It can help to increase access to healthcare services, especially in rural areas where there is a shortage of healthcare professionals.

EHRs enable the digital storage and sharing of patient health records. It can help to improve the quality of healthcare services by providing healthcare professionals with access to complete and up-to-date patient health information.

Challenges in implementing Ayushman Bharat

The implementation of Ayushman Bharat faces several challenges, including:

  • Lack of awareness among eligible beneficiaries.
  • Lack of infrastructure and resources in certain areas.
  • Shortage of healthcare professionals, especially in rural areas.
  • Quality concerns in the provision of healthcare services.
  • Fraud and abuse in the empanelment of hospitals.

Impact of Ayushman Bharat on healthcare system

Ayushman Bharat has had a significant impact on the Indian healthcare system. The scheme has helped to increase access to healthcare services for poor and vulnerable families. It has also helped to reduce the burden of catastrophic health expenditures on families.

Ayushman Bharat has also helped to promote the use of technology in healthcare. It has encouraged the adoption of telemedicine and EHRs, which can help to improve the quality of healthcare services.

Success stories of Ayushman Bharat

Ayushman Bharat has several success stories, including:

  • A 10-month-old baby from a poor family in Uttar Pradesh who underwent a successful heart surgery under Ayushman Bharat.
  • A 26-year-old woman from Rajasthan who received treatment for breast cancer under Ayushman Bharat.
  • A 50-year-old man from Bihar who received treatment for kidney stones under Ayushman Bharat.

Future prospects of Ayushman Bharat

Ayushman Bharat has the potential to transform the Indian healthcare system. The scheme can help to increase access to healthcare services, reduce out-of-pocket expenses, and promote the use of technology in healthcare. However, the implementation of the scheme needs to be improved to address the challenges it faces.

Conclusion

Ayushman Bharat is a landmark scheme launched by the Government of India to provide financial protection to poor and vulnerable families in India. The scheme has helped to increase access to healthcare services and reduce the burden of catastrophic health expenditures on families. Ayushman Bharat has the potential to transform the Indian healthcare system, and its future prospects are promising.

FAQs

  1. What is Ayushman Bhart ? Ayushman Bharat is a scheme launched by the Government of India to provide financial protection to poor and vulnerable families in India by covering their healthcare expenses.
  1. Who is eligible for Ayushman Bharat?

The scheme covers 10.74 crore families identified as deprived rural families and occupational categories of urban workers’ families, who are listed in the SECC database.

  1. What is the role of private hospitals in Ayushman Bharat?

Private hospitals can be empanelled under the scheme if they meet certain eligibility criteria. Empanelled private hospitals are required to provide cashless and paperless treatment to the eligible beneficiaries.

  1. How does Ayushman Bharat promote digital health?

Ayushman Bharat encourages the use of telemedicine and electronic health records (EHRs) to improve healthcare services. Telemedicine enables the remote delivery of healthcare services through technology, while EHRs enable digital storage and sharing of patient health records.

  1. What are the challenges in implementing Ayushman Bharat?

The implementation of Ayushman Bharat faces several challenges, including lack of awareness among eligible beneficiaries, shortage of infrastructure and resources in certain areas, shortage of healthcare professionals, quality concerns in the provision of healthcare services, and fraud and abuse in the empanelment of hospitals.

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