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Ayushman Bharat (ModiCare) – Features, Eligibility, Benefits & Progress Report

Ayushman Bharat scheme has been termed as one of the biggest public healthcare schemes across the globe.

Ayushman Bharat scheme (National Health Mission) is an ambitious scheme launched by Prime Minister Narendra Modi government to achieve the target of creating a healthy and fit India. The program focuses on creating a sound framework of wholistic healthcare where even the economically vulnerable population can have easy access to quality medical care.

To visit the official site- Ayushman Bharat Website

People can visit the government site and look for Ayushman Bharat yojana registration.

Prime Minister Narendra Modi launched the scheme on 23 September 2018. The scheme has now been renamed as Pradhan Mantri Jan Arogya Yojana. It has also been dubbed as MODICARE. With its introduction, it has subsumed two on-going centrally sponsored schemes – Rashtriya Swasthya Bima Yojana (RSBY) and the Senior Citizen Health Insurance Scheme (SCHIS).

Present Minister of Ministry of Health and Family Welfare is Dr. Harsh Vardhan.

Background of PMJAY

India signed the Alma Ata declaration at the International Conference on Primary Health Care 1978 which calls for the declaration of health as a human right for all. However, India’s journey in all these years has proved that the declaration was not adhered to in its real sense. Therefore, a new system of healthcare in the form of Modicare was needed to put in the place that can breathe a new life into the decade-old commitments of the Alma Ata declaration.

almaata_declaration_en

Other reasons for introducing the National Health Mission were ineffective healthcare, expensive cost of treatment and a large population of the diseased-burdened individual.

Funding of PM Jan Arogya Yojana

The total expenditure incurred in the payment of Pradhan Mantri Jan Arogya Yojana will be shared between Central and State Governments in the specified ratio as per the Ministry of Finance guidelines. According to the guidelines, a 60:40 funding pattern will be followed for all states and UTs with their own legislature, while 90:10 pattern will be applied in the Northeast states and the three Himalayan states of Jammu and Kashmir, Himachal and Uttarakhand. For UTs without a legislature, there will be 100 percent central funding.

If needed, additional resources will be taken from the Health and Education Cess too.

Components of National Health Mission

Under the scheme, the government has rolled out two different sub-schemes which are-

1. Health and Wellness Centre

The Union government has promised to establish around 1.5 lakh centers that will bridge the existing gap in our health care system. The centers will offer comprehensive health care (including non-communicable diseases and maternal and child health services). These centers will also provide essential drugs and diagnostic services for free of cost. 

2. National Health Protection Scheme

PMJAY scheme intends to cover over 10 crore poor and vulnerable families (approximately 50 crore beneficiaries). It seeks to provide coverage up to Rs.5 lakh rupees per family per year for secondary and tertiary care hospitalization.

Structure of PMJAY Scheme

An Ayushman Bharat National Health Protection Mission Agency would be set up at the national level to execute the scheme. Similarly, States/ UTs have to implement the scheme by forming a specialized institution called the State Health Agency.

States/ UTs have a choice in picking out the mode for executing this scheme. They can either opt for an insurance company or directly through the Trust/ Society or use an integrated model.

Till now, 32 states/UTs have joined the scheme. Only a few states have abstained from following the Ayushman Yojana program.

Objectives of ModiCare (Ayushman Bharat Scheme)

  1. To make secondary and tertiary healthcare completely cashless in nature.
  2. To provide people with access to medical treatment without putting any pressure on their pockets.
  3. To improve the status of health especially among the most vulnerable sections of society.
  4. To promote the role of private players in the achievement of public health goals.
  5. To improve the quality of life of citizens.
  6. To expand the ambit of the national health framework and inculcate an integrated approach of health-care.
  7. To reduce the out-of-pocket expenditure on healthcare.
  8. To provide insurance cover to a minimum of 40% of the country’s total population
  9. To take the nation closer to the achievement of the Sustainable Development Goal of Universal Health Coverage (SDG3: Good health and well-being).
  10. To create a network of health centers where the focus is on early detection of diseases and providing treatment service for the same.

Target and Eligible population for Ayushman Bharat Scheme

Modicare targets to cover about 10.74 crore poor and deprived families. Out of this, it has been analyzed that 8 crore families are in rural areas while 2.33 crore families are in urban areas that fall under the eligibility criteria.

How to apply for Ayushman Bharat yojana?

Ayushman Bharat registration can be done by the individuals through the official site or reaching out to the nearest Common Service Centres (CSC Ayushman Login).

The beneficiaries of the National Health Mission have been identified using the latest 2011 edition of Socio-Economic Caste Census (SECC)  The scheme will be operational in both rural areas and urban areas, however, there will be different criteria to select the beneficiaries from rural and urban areas.

In the rural areas, the names of beneficiaries have been prepared considering various socio-economic deprivations such as lack of housing facilities, meager income, and other deprivations. Going by this methodology, we arrive at the final list that translates into the following beneficiaries-

  1. Those living in scheduled caste and scheduled tribe households
  2. Families with no male member aged between 16 to 59 years
  3. Beggars and destitute
  4. Families with no individuals aged between 16 and 59 years
  5. Families having at least one physically challenged member and no able-bodied adult
  6. Landless households who are making a living as casual manual laborers
  7. Primitive tribal communities
  8. Legally released bonded laborers
  9. Families living in one-room makeshift houses
  10. Families of Manual scavengers

The urban area list of beneficiaries of Ayushman Bharat has been drawn up on the basis of occupation. Those people from the urban population who can avail the benefits under this scheme are-

  1. Washerman/chowkidars
  2. Home-based artisans or handicraft workers, tailors
  3. Domestic help
  4. Ragpickers
  5. Mechanics, electricians, repair workers
  6. Sanitation workers, gardeners, sweepers
  7. Cobblers, hawkers and others providing services by working on streets or pavements
  8. Plumbers, masons, construction workers, porters, welders, painters and security guards
  9. Transport workers like drivers, conductors, helpers, cart or rickshaw pullers
  10. Assistants, peons in small establishments, delivery boys, shopkeepers, and waiters

The individuals who will not be the part of beneficiaries list are-

  1. Those who own a two, three or four-wheeler or a motorized fishing boat
  2. Those who own mechanized farming equipment
  3. Those who have Kisan cards with a credit limit of Rs.50000
  4. Those who are employed by the government
  5. Those who are working in a government-managed non-agricultural enterprises
  6. Those who are earning a monthly income above Rs.10000
  7. Those who are owning refrigerators and landlines
  8. Those who have a decent and solidly built houses
  9. Those who own 5 acres or more of agricultural land

Provisions and Benefits of Ayushman Bharat

  1.  A beneficiary covered under the scheme will be allowed to take cashless benefits from any public/private empanelled hospitals across the nation.
  2. Both pre and post-hospitalization expenses are covered under the scheme.
  3. It provides a boost to the concept of co-operative federalism by offering flexibility to states to decide their mode of implementation.
  4. Benefit cover has been increased to cover nearly 40% of the vulnerable population.
  5. It covers almost all secondary and many tertiary hospitalization procedures.
  6. The scheme will cover benefits up to Rs. 5 lakh for each family with no restriction on the family size.
  7. It will help in reducing the incidence and impact of non-communicable diseases.

The scheme covers a variety of serious ailments and critical diseases. Few of those covered under the scheme are-

  • Prostate cancer
  • Coronary artery bypass grafting
  • Double valve replacement
  • Carotid angioplasty with stent
  • Pulmonary valve replacement
  • Skull base surgery
  • Laryngopharyngectomy with gastric pull-up
  • Anterior spine fixation
  • Tissue expander for disfigurement following burns

However, the scheme has the following Exceptions-

  • OPD
  • Cosmetic related procedures
  • Fertility related procedures
  • Drug rehabilitation program
  • Organ transplants
  • Individual diagnostics (for evaluation)

Progress Report of PMJAY

In just a year since its launch, Pradhan Mantri Jan Arogya Yojana has successfully completed 50 lakh hospital admissions. 9 hospital admissions were recorded every minute across the country under this scheme. Gujarat, Tamil Nadu, Chhattisgarh, Kerala, and Andhra Pradesh have been ranked as the top-performing states under the scheme.

As of September 2019, it was reported that 18,059 hospitals have been empanelled, and over 4,406,461 lakh beneficiaries have been admitted and. In the same duration, over 10 crore e-cards have been issued.

According to the data of the National Health Authority, more than 60 percent of the amount was found to be spent on tertiary care.

Conclusion

If one looks at the existing infrastructure of health facilities, it can be easily observed that the present framework does not allow everyone to access it with the same ease and affordability. Therefore, creating an integrated network of health centers for the poor souls is a necessary step towards development.

A healthy India is a pre-requisite for the enthusiastic labor force participation, therefore taking care of the most vulnerable sections, especially those who are underprivileged is imperative for a welfare state like India. In this regard, Ayushman Bharat scheme is a health program with noble objectives that can go a long way to transform the quality of the country’s demographic dividend.

A healthy population to the nation is like an army of strong soldiers, leading towards the war of development and growth.” 

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