India has witnessed the launch of the biggest government-sponsored healthcare scheme in the world known as Ayushman Bharat in which the number of beneficiaries is so large that it can cover the people in India equal to total population Canada, Mexico and the US. The insurance scheme is named as Ayushman Bharat-Pradhan Mantri Jan Aarogya Yojana (AB-PMJAY). It will have a well-defined health cover of five lakh rupees per family per year. There was a general debate on whether the scheme has the ability to offer respite to India’s poor and vulnerable. The benefits of the scheme are valid across the country and cashless benefits are available in public/private hospitals listed under the scheme for the beneficiary covered under the scheme anywhere in India.
How does Ayushman Bharat work?
The entitlement will be based on the deprivation criteria in the SECC database. The package rates for payments of treatments will be decided by the government. Ayushman Bharat National Health Protection Mission Council (AB-NHPMC) will be the apex body for policy directions and fostering coordination between center and states. State Health Agency (SHA) is the authority at the state level to implement the scheme. The transfer of funds will be done through an escrow account directly from the center to state so that the funds will be available on time.
The most important aspect of the scheme is its cashless and paperless transactions through a robust and scalable digital platform. A cover of five lakhs per year towards hospitalization expenses of their family members is provided. Apart from the expenses on hospitalizations treatment, the scheme also covers pre and post hospitalization costs to in certain cases. The beneficiaries will not be required to pay any charges and premium for the hospitalization expenses.
‘Ayushman Mitra’ – the health serviceman to assist the beneficiaries, will be appointed in each empanelled hospital and will act as coordinator between hospital and beneficiary. These staff members will run a help desk in order to enrolment patients in the scheme. They will also check the documents to verify the eligibility.
What are the benefits?
Eligible families from SECC database have already been listed and shared with the state governments and respective departments. They will get a unique AB-NHPM family identification number allotted to them. Only families whose name is on the list with identification number are eligible for the benefits of AB-NHPM.
There are a total of 1,354 packages in the scheme included by the health ministry under which treatment for coronary bypass, knee replacements, and many other health ailments will be provided at almost twenty percent cheaper rates.
Why public health insurance is needed?
The NSSO presented some alarming statistics in 2015 on how medical emergencies and expenses on healthcare thereafter disturb the financial security of poor families in India. There was the steep rise in hospitalization expenses, especially for critical ailments in the past few decades. As the expenses are usually paid through the sale of assets that bring income to the family, health ailments are nothing short of a disaster for poor families. An estimated six million families are falling into poverty each year due to hospitalization. By targeting lower rungs of the socio-economic ladder this scheme provides immunity to these families against the financial losses from sudden medical emergencies. This will take away the economic forces that push these people towards the depths of poverty and will help in uplifting both the economic status and quality of life for the poor.
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