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Ayushman Bharat Yojana:
The Indian government realized the goal of Universal Health Coverage (UHC), and it introduced Ayushman Bharat, a flagship program, that was advised by the National Health Policy 2017. In this project, the sustainable development goals (SDGs) and their core promise to "leave no one behind" are being addressed.
The goal of Ayushman Bharat is to achieve a transition in the delivery of health services from a sectoral and segmented model to a comprehensive, need-based approach. The healthcare system was addressed holistically—addressing palliative care, promotion, and prevention—at the primary, secondary, and tertiary levels, this program intends to implement ground-breaking interventions. The Ayushman Bharat initiative consists of two interconnected components:
- Wellness and Health Centers (HWCs), now known as Aushyman Arogya Mandir (AAM)
- Pradhan Mantri Jan Arogya Yojana (PM-JAY)
1. Centers for Health and Wellness (HWCs)/ Ayushman Arogya Mandir (AAM):
In February 2018, the Indian government stated that 1,50,000 Health and Wellness Centers (HWCs) would be created by converting the country's Sub Centers and Primary Health Centers. Establishing services like comprehensive primary health care (CPHC) will enable patients to receive medical care closer to their homes. They include free necessary medications, diagnostic services, and services related to non-communicable diseases and maternal and child health.
To meet the primary healthcare needs of the local population by providing a wider range of services, Ayushman Arogya Mandir (AAM) aims to increase equity, accessibility, and universality in the community. By empowering people to make healthy choices and adopt lifestyle modifications that lower their risk of chronic illness and morbidity, communities and individuals are encouraged to select healthful behaviors. This is the main goal of health promotion and prevention.
2. The PM-JAY, or Pradhan Mantri Jan Arogya Yojana:
The second component of Ayushman Bharat is the PM-JAY or Pradhan Mantri Jan Arogya Yojana. The Hon. Prime Minister of India, Shri Narendra Modi, launched this initiative at Ranchi, Jharkhand, on September 23, 2018.
Bharat Ayushman The largest health assurance program in the world, PM-JAY, aims to give over 12 crore poor and vulnerable families—roughly 55 crore beneficiaries—who make up the bottom 40% of the Indian population, a health cover of Rs. 5 lakhs per family per year for secondary and tertiary care hospitalization. The Socio-Economic Caste Census 2011 (SECC 2011) deprivation and occupational criteria for rural and urban areas, respectively, are used to determine the inclusion of households. Before its rebranding, PM-JAY was known as the National Health Protection Scheme (NHPS). It was merged with the 2008-launched Rashtriya Swasthya Bima Yojana (RSBY). Consequently, the coverage described under PM-JAY also includes families who were covered by RSBY but are not included in the SECC 2011 database. The Central and State Governments split the implementation costs of PM-JAY, which is entirely supported by the Government.
Crucial Elements of PM-JAY:
- The largest health insurance and assurance program in the world, PM-JAY is wholly funded by the government.
- It offers coverage for secondary and tertiary care hospitalization in both public and private institutions in India up to Rs. 5 lakhs per family annually.
- Over 55 crore people, or over 12 crore underprivileged and vulnerable families, are eligible for these benefits.
- The PM-JAY program provides the beneficiary with cashless access to medical treatments at the hospital, which is the point of service.
- The goal of PM-JAY is to lessen the staggering medical costs that force around 6 crore Indians into poverty every year.
- It covers the cost of prescription drugs and diagnostic tests for a maximum of three days prior to hospitalization and fifteen days following hospitalization.
- There are no restrictions on the family's size, age, or gender.
- All pre-existing conditions are covered right away.
The benefits of the scheme are available across the country i.e. a beneficiary can visit any impaneled public or private hospital in India to avail of cashless treatment. Public hospitals get paid the same as private hospitals for the medical services they provide.
PM-JAY Benefit Coverage:
Benefits coverage under India's different state-funded health insurance programs has traditionally been capped at INR30,000 per family per year, with the maximum amount varying across States, leading to a disjointed system. Every qualifying household can receive a cashless cover of up to INR5,00,000 from PM-JAY annually for specified secondary and tertiary medical problems. The following therapy components have all associated expenses covered by the plan.
- Medical diagnosis, care, and advice
- Prior to hospitalization
- Pharmaceuticals and supplies for healthcare
- Services for both intensive and non-intensive care
- Laboratory and diagnostic tests
- Services for medical implantation (when necessary)
- Accommodation advantages
- Catering services
- Problems that develop while receiving treatment
- Up to 15 days of post-hospitalization follow-up care
The services include about 1,929 procedures and all treatment-related charges, including prescription drugs, supplies, diagnostic tests, physician fees, hotel expenditures, surgeon fees, OT and ICU fees, etc.
Since the benefits are given on a family floater basis, one or more family members may be eligible to receive INR 5,00,000. In the RSBY, a family may only consist of five people. However, based on the knowledge gained from previous programs, PM-JAY was developed with no upper restriction on the number of family members or their ages. In addition, pre-existing condition coverage starts on the first day. This suggests that anyone who qualifies and has a medical condition that PM-JAY did not previously cover at the time of enrollment will also be eligible to receive treatment for that disease.
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