New Delhi: The Government of India launched the historic Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) on September 23, 2018. This was launched as the world’s most ambitious public health insurance (PHI) programme. The scheme was envisaged under the leadership of Prime Minister Narendra Modi, with a focus to provide free access to health insurance to the low-income group in the country.


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True to its name, the scheme has been delivering value and promise of health to an ever-increasing section of the target group, which roughly comprises the bottom 50% of the country in the socio-economic pyramid. The scheme promises all eligible beneficiaries with cashless and paperless healthcare benefits of up to ₹ 5 lakh per family per year. As a result, it has empowered many disenfranchised sections of the society and has prevented them from falling prey to a vicious cycle of poverty and harassment by loan sharks for as basic a need as healthcare.


Since its inception, the scheme has been consistently bringing both private and public health facilities within its coverage network. Until August 2021, the government had brought about 23,000 public and private empanelled hospitals within its ambit to provide health services to patients in 33 states and union territories of the country. As it stands, over 2 crore hospital admissions have been completed under this scheme, and about ₹ 25,000 crore worth of treatment has been dispensed.


The dream of an ‘Ayushman Bharat’ is being continuously achieved through the relentless contribution of state governments in bringing its eligible citizens under the ambit of the scheme. Some of the states have shown tremendous commitment to the central government’s mandate by leading the tally in the verification and enrolment of eligible beneficiaries.


According to the data released last year by the Union Health Ministry, Madhya Pradesh has led the tally with 24,791,352 crore registrations, followed by Tamil Nadu (24,727,508), Uttar Pradesh (14,189,874), Chhattisgarh (13,240,939), Karnataka (9,782,602), Jharkhand (8,992,890), and Gujarat (7,641,318). In terms of disbursing health benefits through authorised hospital admissions, Tamil Nadu and Gujarat have been ahead of other states having provided a value of over ₹3800 crore and ₹3600 crore, respectively. Meanwhile, other states like Andhra Pradesh (₹3500+), Karnataka (₹1700+), Kerala (₹1900+), Chhattisgarh (1500+), Maharashtra (₹1200+) and Madhya Pradesh (₹1200+) have also contributed substantially to making the scheme a roaring success.


We need to commit to continuously improving the public health services at the grassroots through innovative approaches. For instance, Madhya Pradesh Health Department has deployed an innovation by working on implementing an online facility to train Lok Seva Kendras (LSKs) and Mitra Kiosks (MKs) at empanelled hospitals to make the Ayushman Bharat-PMJAY cards and increase enrolment, bringing more eligible beneficiaries under the ambit of the scheme. Madhya Pradesh has also received national accolades for its intent and execution to include left-out poor families within the ambit of Ayushman Bharat. In a coordinated effort with the state government, the State Health Agency (SHA) identified Sambal Yojana and the National Food Security Act to secure the list of poor families receiving the benefits under these schemes. These names were then included in the Socio-Economic and Caste Census 2011 (SECC-2011) database through Samagra ID, which is a live database of citizens and has been used to verify left-out families to provide PM-JAY benefits.


In the same direction, the central government also designed a slew of innovative incentives to promote state-of-the-art healthcare service delivery under AB-PMJAY. The public hospitals empanelled under AB-PMJAY are reimbursed for treatment provided under the scheme at par with the cost reimbursed to their private sector counterparts. These funds can be leveraged by such institutions to carry out infrastructural development and establish state-of-the-art facilities. The National Health Authority (NHA) had issued necessary guidelines and instructions to the SHAs and public hospitals to encourage this.


In fact, many states like Karnataka, Madhya Pradesh, Maharashtra, and Uttar Pradesh, among others have effectively used the funds allocated to public hospitals for infrastructure up-gradation and for providing better amenities to beneficiaries. The NHA has partnered with the Quality Council of India to develop a quality certification program for empanelled hospitals. AB-PMJAY quality certifications include Bronze, Silver, and Gold Quality certifications. The hospitals achieving PMJAY Gold, Silver and Bronze certifications are provided 15%, 10% and 5% higher package rates, respectively.


In the last two years, healthcare facilities across the world have suffered a major setback under the pressure of the COVID-19 pandemic. Despite the limitations posed by the pandemic, India has successfully ploughed through this unprecedented time having shown a matchless example of tough political will both at the centre and especially at the state levels. During the pandemic, while there was a noticeable impact on the uptake of the scheme on account of factors such as restriction of mobility, restrictions on elective surgeries, reluctance from scheme beneficiaries to visit hospitals due to fear of infection and designation of public facilities as dedicated COVID centres, AB-PMJAY provided valuable support to the healthcare ecosystem by ensuring that beneficiary registration process was kept active and empanelled hospitals continued to provide services to the scheme beneficiaries.


Today, as we observe the Ayushman Bharat Diwas, it is evident that the Ayushman Bharat scheme has shown deep commitment in its vision to promote health and wellness to the poor and also to provide insurance benefits to them. We are nearing the momentous day when PM Modi’s vision of Atmanirbhar Bharat, in the area of health and wellness, will be achieved by an effective implementation of the Ayushman Bharat scheme.


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