AYUSHMAN BHARAT
1. Context
Highlighting irregularities in the registration and validation of beneficiaries under the Ayushman Bharat – Pradhan Mantri Jan Aarogya Yojana (PMJAY), the Comptroller and Auditor General of India (CAG) has revealed that nearly 7.5 lakh beneficiaries were linked with a single cellphone number - 9999999999.
2. About Ayushman Bharat Scheme
The Ayushman Bharat scheme, officially known as the Pradhan Mantri Jan Arogya Yojana (PM-JAY), is a flagship healthcare initiative launched by the Government of India in September 2018. It is aimed at providing financial protection and access to quality healthcare services to a significant portion of India's population, especially those who are economically disadvantaged and vulnerable.
The scheme has two main components:
- Health and Wellness Centers (HWCs): This component aims to transform the existing sub-centers and primary health centers into Health and Wellness Centers. These centers serve as the first point of contact for individuals seeking healthcare services. They offer a range of preventive, promotive, and basic healthcare services, including maternal and child health services, communicable disease management, and health education.
- Pradhan Mantri Jan Arogya Yojana (PM-JAY): PM-JAY is the larger component of the Ayushman Bharat scheme, focused on providing health insurance coverage to economically vulnerable families. It offers financial protection against catastrophic health expenses by covering the cost of hospitalization and certain medical procedures. PM-JAY provides coverage up to ₹5 lahks (per family per year) for secondary and tertiary care hospitalization. This includes coverage for a wide range of medical treatments, surgeries, and therapies.
3. Key features of PM-JAY include:
- Universal Coverage: PM-JAY covers over 10 crore (100 million) vulnerable and economically disadvantaged families, which is approximately 50 crore individuals, making it one of the largest government-funded healthcare insurance programs in the world.
- Cashless Transactions: Beneficiaries can avail of cashless and paperless healthcare services at any empanelled public or private hospital across the country.
- Portability: The scheme is portable, meaning beneficiaries can access services in any part of the country, irrespective of where they are registered under the scheme.
- No Cap on Family Size: The benefits under the scheme are not limited by family size or age, providing comprehensive coverage to all eligible family members.
- Priority for Women and Senior Citizens: The scheme gives priority to women, senior citizens, and individuals from marginalized communities.
- Empanelled Hospitals: The scheme has a network of public and private hospitals that have been empanelled to provide services under PM-JAY.
4. What is National Health Authority (NHA)?
- The National Health Authority (NHA) is the apex body responsible for the implementation and management of the Pradhan Mantri Jan Arogya Yojana (PM-JAY), also known as Ayushman Bharat, in India.
- It was established as an autonomous body by the Government of India in January 2019.
- The NHA plays a crucial role in the effective execution of the world's largest government-funded health insurance scheme.
Key functions and responsibilities of the National Health Authority include:
- Policy Formulation: The NHA is responsible for formulating policies and guidelines for the implementation of PM-JAY. It works to ensure that the scheme aligns with the broader objectives of universal health coverage and affordable healthcare for all.
- Enrollment and Beneficiary Identification: The NHA oversees the process of identifying and enrolling eligible beneficiaries for PM-JAY. This involves creating and maintaining a comprehensive database of eligible families to ensure accurate and efficient access to healthcare services.
- Empanelment of Hospitals: The NHA empanels both public and private hospitals to participate in the scheme. These hospitals are evaluated based on their infrastructure, facilities, and willingness to provide services under PM-JAY. Empanelled hospitals provide cashless and quality healthcare services to beneficiaries.
- Claims Management: The NHA is responsible for managing the claims process, which includes processing and reimbursing hospitals for the healthcare services provided to beneficiaries. This process ensures that beneficiaries can access medical treatment without facing financial barriers.
- Monitoring and Quality Assurance: The NHA monitors the implementation of PM-JAY to ensure that the services provided by empanelled hospitals meet quality standards. It conducts regular audits and assessments to maintain the quality of healthcare services.
- Technology and Data Management: The NHA employs technology extensively to manage beneficiary data, hospital empanelment, claims processing, and monitoring. This helps in creating an efficient and transparent system for the implementation of the scheme.
- Capacity Building: The NHA works on capacity-building initiatives for stakeholders involved in the implementation of PM-JAY. This includes training for healthcare providers, government officials, and other relevant personnel.
- Research and Innovation: The NHA focuses on research and innovation to improve the implementation of PM-JAY. It explores ways to enhance the scheme's reach, effectiveness, and impact.
5. Is National Health Authority a Statutory Body?
- The National Health Authority (NHA) is a statutory body. It was established by an Act of Parliament known as the " National Health Authority Act, 2019.
- The Act was passed to provide a legal framework for the creation and functioning of the NHA, which is responsible for the implementation of the Pradhan Mantri Jan Arogya Yojana (PM-JAY), also known as Ayushman Bharat.
- The National Health Authority Act, 2019, outlines the composition, Powers, functions, and responsibilities of the NHA.
- It grants the NHA the authority to manage and oversee the implementation of PM-JAY, which is one of the largest government-funded health insurance schemes in the world.
- The Act also provides the NHA with the necessary legal framework to carry out its role effectively, including policy formulation, enrollment of beneficiaries, empowerment of hospitals, claims processing, and quality assurance.
- As a statutory body, the National Health Authority operates within the legal framework provided by the Act and has the authority to make decisions, issue guidelines, and implement policies related to the functioning of PM-JAY.
- This legal status ensures that the NHA has the necessary autonomy and powers to carry out its responsibilities in the implementation of the healthcare scheme.
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For Prelims: Ayushman Bharat, Pradhan Mantri Jan Aarogya Yojana (PMJAY), the Comptroller and Auditor General of India (CAG), Health and Wellness Centers (HWCs), National Health Authority (NHA).
For Mains: 1. Discuss the significance, achievements, and challenges of the Ayushman Bharat scheme in the context of achieving universal health coverage in India. (250 Words).
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Previous year Question
1. With reference to Ayushman Bharat Digital Mission, consider the following statements: (UPSC 2022)
1. Private and public hospitals must adopt it.
2. As it aims to achieve universal health coverage, every citizen of India should be part of it ultimately.
3. It has seamless portability across the country.
Which of the statements given above is/are correct?
A. 1 and 2 only
B. 3 only
C. 1 and 3 only
D. 1, 2 and 3
Answer: B
2. With reference to 'Ayushman Bharat Yojana' which of the following statement(s) is/are correct? (UPPSC 2020)
1. This Yojana provides free health insurance of Rs. 5 lahks per person.
2. The expenses incurred in this Scheme (Yojana) is shared between the Centre and State in a 60:40 ratio.
Select the correct answer from the codes given below.
A. 1 only
B. 2 only
C. Both 1 and 2
D. Neither 1 nor 2
Answer: B
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Source: The Indian Express
