AYUSHMAN BHARAT SCHEME | AYUSHMAN BHARAT- NATIONAL HEALTH PROTECTION MISSION

 

Ayushman Bharat

In a report by NSSO-2015, it was mentioned that in the last 10 years in-patient hospitalization expenditure in India has increased by 300%. People in India are reluctant to enroll themselves into health or life insurance schemes available in the market or given by the government and at the hour of need end up paying more than 80% of medical expenditures out of pocket by using either their savings or by borrowings. Such kind of uncertain expenses ends up pushing approximately 6 million families below the poverty line.

A matter of worry is that India is not yet a financially inclusive country and to become one it is essential to educate its citizens with financial knowledge which is a medium to long-term time taking thing. To deal with this situation government had an urgent need to implement a policy that should be effective as well as efficient at the same time hence government arrived with this scheme which is:

• World’s largest government-funded health assurance scheme

•  Portable across the country; completely cashless as well as paperless

•  Provide health assurance of Rs 5lakh per family per year without cap on family size, age, or gender

• It covers all secondary and most tertiary care expenditures.

• Covers 3 days of pre-hospitalization and 15 days of post-hospitalization expenses like :
• Medicines
• Transport allowances
• Accommodation
• Food services
• Lab and diagnostic expenses
• Medical implantation
• Intensive as well as non-intensive care services

The scheme is funded by the government and shared between the center and state in proportion as decided by the finance ministry. It is an entitlement-based scheme, beneficiary families do not require enrollment. To verify genuineness, beneficiary verification is being undertaken. Ayushman cards are issued to all beneficiaries for easy availing of health benefits. Rs  6400 crore funds were allocated for the scheme for the financial year 2021-2022.

Beneficiary families under the scheme are decided based on SECC-2011 and have 3 different selection criteria; one for automatically included people and another 2 for rural and urban populations respectively.

List of automatically included people:

• ·       Families without shelter

• ·       Destitute

• ·       Manual scavengers

• ·       Primitive tribal

• ·       Bonded labors (released legally)

List of families from the rural areas :

• ·       Families residing in 1 room and are kutcha house

• ·       No member of age 16-59

• ·       Male age 16-59 but not able-bodied

• ·       Female-headed household without any male of age 16-59

• ·       Scheduled caste and scheduled tribe families

• ·       Landless households working as manual casual labor

List of families from the urban areas :

Families to be entitled to the Ayushman Bharat scheme from the urban areas are classified on an occupation basis. Families considered belong to the job of rag picker, beggar, mechanic, plumber, domestic work, construction worker, welder, transport worker, rickshaw puller, washer man, etc.

The scheme is implemented in 3 tier model 

•  Apex body: National Health Authority; which is an attached office of the ministry  of  health and family welfare contains functional autonomy

• State / Union Territory Level: State Health Agency; state have been provided with the flexibility to implement the scheme in an operational model best suited to local conditions thus implemented through:-

• Insurance mode
• Trust mode
• Mixed mode

• District level: District Implementation Units; these units ensure coordination between stakeholders to enable smooth implementation on the ground.

Being a pan-India scheme with a top-down approach this scheme is providing economic support and brings financial inclusion to the country; helping in poverty alleviation and good health hand in hand.

 

 - Bhavna Geed