Ayushman Bharat PMJAY ? 5 years of caring

Ayushman Bharat PMJAY – 5 years of caring

News: It has been 5 years since the AB-PMJAY has been launched.

Background:
• This editorial talks about the strength and achievements of the scheme.
• Some of the data can be handy for your mains answers.

What is Ayushman Bharat Pradhan Mantri Jan Arogya Yojana?
• The scheme provides a health cover of Rs 5 lakh per family per year for secondary and tertiary care hospitalisation to more than 12 crore families (bottom 40 per cent of the population), making it the world’s largest health assurance scheme.
• The scheme has taken the country closer to Sustainable Development Goal 3.8, which envisions universal health coverage.

Key Achievements of the scheme:
• So far, more than 24 crore Ayushman Cards have been created and 27,000 hospitals have empaneled.
• The scheme over the past 5 years have helped save more than Rs. 1 lakh crore for all beneficiaries. They would have spent twice more the amount on healthcare had it not been for the scheme.
• The scheme has reduced the Out of Pocket Expenditure(OOPE) of the beneficiaries by 60 % and increased their access to tertiary care by 65 %.
• 48 per cent of treatments under the scheme have been
availed by women.
• To elicit the participation of private service providers, health benefit packages (HBPs) — covering all inpatient treatment — have been revised five times in the last five years including Cancer treatment.
• Every hospital is mandated to have dedicated Pradhan Mantri Arogya Mitras (PMAMs) who guide the beneficiaries.
• It also provides for Interstate portability which ensures migrants can avail treatment during emergency situations.
• Service delivery is end-to-end digitised, obviating systemic bias.
• The NHA has been using Artificial Intelligence (AI) and Machine Learning (ML) technologies to detect suspicious transactions/potential frauds. Over 210 hospitals have been de-empaneled.
• The scheme has launched several innovations and initiatives to enhance the quality and accessibility of healthcare services. Some of these are Ayushman Bharat Digital Mission (ABDM), Ayushman Bharat Health Infrastructure Mission (ABHIM), Ayushman Bharat PM-JAY Startup Grand Challenge, Ayushman Bharat PM-JAY Awards, etc.
• The NHA’s call centre makes calls to every beneficiary who has availed treatment within 48 hrs of discharge to verify the quantity and quality of the treatment. Another call is made after 15 days to know about the prognosis.
• The AB-PMJAY scheme added people from the transgender community to its list of beneficiaries.

Challenges:
• Ensuring timely and adequate reimbursement of claims to the empanelled hospitals, especially private ones. Many hospitals have complained of delayed payments, low package rates, high denial rates, and cumbersome processes.
• The scheme faces a low awareness level among the potential beneficiaries, especially in rural areas. Many eligible beneficiaries are not aware of their entitlements or how to avail them.
• Supply side constraint due to uneven distribution and availability of healthcare infrastructure.