Ayushman Bharat Card : 5 ಲಕ್ಷದವರೆಗೆ ಉಚಿತವಾಗಿ ಅರೋಗ್ಯ ಸೇವೆ ಸರ್ಕಾರಿ ಹಾಗು ಖಾಸಗಿ ಹಾಸ್ಪಿಟಲ್ ನಲ್ಲಿ ಸಿಗುತ್ತೆ ಈ ಕಾರ್ಡ್ ಮಡೆದುಕೊಳ್ಳಿ
Ayushman Bharat
Introduction
Ayushman Bharat is a revolutionary healthcare initiative launched by the Government of India in 2018. Also known as the Prcadhan Mantri Jan Arogya Yojana (PM-JAY), it aims to provide affordable healthcare services to millions of Indians, particularly the economically vulnerable. This ambitious program, described as the world’s largest government-funded healthcare initiative, is designed to achieve the vision of Universal Health Coverage (UHC).
In this detailed guide, we will delve into the key components of Ayushman Bharat, its objectives, benefits, implementation, and the challenges it faces. This article will also provide a detailed breakdown of how the scheme works, who is eligible, and how it is transforming healthcare access across India.
1. The Origins of Ayushman Bharat
Ayushman Bharat was launched as part of the Government of India’s efforts to address the vast inequalities in healthcare access, especially for the underprivileged. Healthcare costs have been a significant burden on low-income families, often pushing them into poverty due to out-of-pocket expenses.
Before Ayushman Bharat, healthcare in India was largely fragmented, with limited access to insurance schemes that covered essential healthcare services. Several state-level insurance schemes existed, but they were inconsistent and did not provide a nationwide safety net. Recognizing the need for a unified approach, the government launched Ayushman Bharat with two primary components:
- Health and Wellness Centres (HWCs): Focused on providing primary care.
- Pradhan Mantri Jan Arogya Yojana (PM-JAY): Focused on secondary and tertiary healthcare services.
2. Key Objectives of Ayushman Bharat
The overarching goal of Ayushman Bharat is to achieve Universal Health Coverage (UHC), ensuring that every citizen, irrespective of their socio-economic status, has access to quality healthcare services. The key objectives include:
- Reducing Financial Hardship: By covering healthcare costs, the scheme aims to prevent low-income families from sinking into poverty due to medical expenses.
- Ensuring Access to Healthcare Services: Providing health insurance coverage to over 100 million families in India, which translates to approximately 500 million individuals.
- Preventive Healthcare: Promoting wellness and preventive care through Health and Wellness Centres (HWCs).
- Providing Comprehensive Healthcare Services: From primary to tertiary care, covering a wide range of medical conditions.
- Boosting Public and Private Healthcare Infrastructure: Encouraging private sector participation to improve healthcare accessibility and quality.
3. Ayushman Bharat: A Two-Pronged Approach
Ayushman Bharat operates through two main pillars:
A. Health and Wellness Centres (HWCs)
Ayushman Bharat has transformed around 1.5 lakh sub-centers and primary health centers into Health and Wellness Centres (HWCs), making healthcare more accessible at the grassroots level. These centers focus on preventive, promotive, and curative care, providing services like maternal and child health care, immunization, screening for non-communicable diseases (like diabetes and hypertension), and essential medicines. The HWCs also focus on health education to create awareness about hygiene, nutrition, and lifestyle diseases.
B. Pradhan Mantri Jan Arogya Yojana (PM-JAY)
The second component, PM-JAY, aims to provide free secondary and tertiary care hospitalization for approximately 10 crore families, which includes around 50 crore individuals.
PM-JAY provides insurance coverage of up to ₹5 lakh per family per year for medical treatments. Beneficiaries can access cashless and paperless healthcare services across public and empaneled private hospitals. This initiative covers more than 1,500 medical conditions and surgeries, including critical treatments like cancer, heart surgery, and kidney transplants.
4. Eligibility Criteria for Ayushman Bharat
Ayushman Bharat is targeted at the poorest sections of society. The eligibility is primarily based on the Socio-Economic Caste Census (SECC) 2011 data, and it uses a deprivation criterion to identify beneficiaries. The scheme divides the rural and urban populations into different categories:
A. Rural Eligibility Criteria
For rural areas, the scheme focuses on families that meet one or more of the following conditions:
- Households with no adult members aged 16 to 59.
- Female-headed households with no adult male members.
- Families living in a one-room house with kutcha (mud) walls and roof.
- Households with disabled members and no able-bodied adult member.
- SC/ST households.
- Landless households earning a major part of their income from manual casual labor.
B. Urban Eligibility Criteria
In urban areas, the beneficiaries are identified based on occupation, including:
- Rag pickers.
- Domestic workers.
- Street vendors, hawkers, and cobblers.
- Plumbers, construction workers, masons, and laborers.
- Shop workers, drivers, and other manual laborers.
5. Benefits and Coverage Under Ayushman Bharat
The scope of Ayushman Bharat is extensive, offering multiple benefits:
- Coverage for Hospitalization Costs: Ayushman Bharat covers both pre- and post-hospitalization costs. This includes tests, medications, and surgeries.
- Cashless and Paperless Services: Beneficiaries can receive treatment without any upfront payment at empaneled hospitals across India.
- Coverage of All Pre-Existing Conditions: From the day the beneficiary is enrolled, all pre-existing conditions are covered under the scheme.
- Transport Allowance: In some cases, beneficiaries are provided with transportation costs.
- Empaneled Hospitals Across India: Beneficiaries can avail services from a network of empaneled hospitals, including public and private hospitals.
- No Cap on Family Size or Age: The scheme is designed to cover entire families without imposing any restrictions based on family size or age.
6. How Does Ayushman Bharat Work?
The functioning of Ayushman Bharat involves multiple stakeholders, from the central and state governments to insurance companies and healthcare providers. Here’s a breakdown of the process:
- Identification of Beneficiaries: Eligible families are identified using the SECC data, and they receive a PM-JAY e-card, which contains all relevant information for accessing healthcare services.
- Hospitalization and Treatment: Beneficiaries can approach empaneled hospitals (both public and private) and seek treatment for any of the covered medical conditions. The treatment is entirely cashless.
- Role of Hospitals: Hospitals have to be empaneled under the Ayushman Bharat scheme and are expected to follow all government protocols in delivering healthcare services. Hospitals receive payments from the government based on treatment packages predefined by the scheme.
- Insurance Providers and Trust Model: In some states, Ayushman Bharat operates on an insurance model, where insurance companies manage the funds. In others, it follows a trust model where the state government itself pays for healthcare expenses.
7. Challenges Facing Ayushman Bharat
Despite its success, Ayushman Bharat faces several challenges:
- Awareness Among Beneficiaries: Many eligible families remain unaware of their entitlements under the scheme, particularly in remote areas.
- Hospital Empanelment: While private hospitals play a crucial role, many remain reluctant to join the scheme due to concerns over low reimbursement rates and delays in payments.
- Fraud Prevention: Ensuring that only eligible beneficiaries access services and preventing fraudulent claims is an ongoing challenge for the scheme.
- Capacity of Public Hospitals: The surge in demand for services due to Ayushman Bharat has put a strain on public healthcare infrastructure, which is often under-resourced.
- Quality of Healthcare: Maintaining consistent quality standards across all empaneled hospitals is crucial to the scheme’s success.
8. Success Stories and Impact
Ayushman Bharat has transformed the healthcare landscape in India. By October 2023, millions of people had benefited from the scheme, with treatments provided for conditions like cancer, cardiovascular diseases, and kidney disorders, among others.
In several states, Ayushman Bharat has reduced the burden on families by covering significant medical expenses. Some of the most common procedures performed under the scheme include dialysis, heart surgeries, joint replacements, and cancer treatments.
9. The Future of Ayushman Bharat
The future of Ayushman Bharat lies in expanding its reach and improving healthcare infrastructure, particularly in rural areas. The government is also working on integrating technology through initiatives like Ayushman Bharat Digital Mission (ABDM), which aims to create a digital health ID for every citizen, facilitating seamless access to health records.
In addition, ongoing efforts are being made to strengthen partnerships with the private sector, improve fraud detection mechanisms, and enhance the capacity of public healthcare systems to ensure the success of the scheme in the long run.
Conclusion
Ayushman Bharat represents a significant step toward ensuring equitable healthcare access for every Indian citizen. While challenges remain, the scheme’s large-scale impact, particularly on the economically vulnerable, underscores its importance as a transformative healthcare initiative. By covering millions of families and providing comprehensive health insurance, Ayushman Bharat is not just addressing immediate medical needs but is also building a healthier future for India.
