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Ayushman Bharat, a visionary initiative of the Government of India, is poised to transform the nation’s healthcare landscape. In line with the National Health Policy 2017, this flagship scheme has a singular aim – to achieve Universal Health Coverage (UHC), ensuring that no one is left behind in accessing quality healthcare. Its roots can be traced back to the pressing need for comprehensive healthcare reform in India, where the healthcare system faced challenges of fragmentation and limited access, particularly for economically vulnerable segments of society. Recognizing these challenges, the government embarked on a journey to restructure and revamp the healthcare landscape.
Components of Ayushman Bharat
Health and Wellness Centres (HWCs)
The foundation of Ayushman Bharat lies in its Health and Wellness Centres (HWCs), introduced in February 2018. These centers represent a fundamental shift in healthcare delivery by bringing it closer to people’s homes. The goal is to deliver Comprehensive Primary Health Care (CPHC), addressing a wide spectrum of health needs, from maternal and child health services to non-communicable diseases. Moreover, HWCs provide essential drugs and diagnostic services, ensuring holistic care and making healthcare more accessible to communities.
Pradhan Mantri Jan Arogya Yojana (PM-JAY)
Launched in September 2018, PM-JAY is a monumental step towards universal healthcare. It is the world’s largest health assurance scheme, offering a substantial health cover of up to Rs. 5 lakhs per family per year for secondary and tertiary care hospitalization. This ambitious initiative specifically targets over 12 crores economically disadvantaged families, encompassing approximately 55 crore beneficiaries. PM-JAY not only replaces the earlier Rashtriya Swasthya Bima Yojana (RSBY) but also covers families not present in the SECC 2011 database, ensuring that a broader section of society gains access to quality healthcare.
Key Features of PM-JAY
PM-JAY boasts several distinctive features, setting it apart as a groundbreaking healthcare initiative:
- Government Financing: The scheme is entirely government-funded, ensuring comprehensive coverage without financial burden on beneficiaries.
- Cashless Access: Beneficiaries have the privilege of cashless access to healthcare services at both public and private empanelled hospitals, ensuring smooth and hassle-free medical care.
- Comprehensive Coverage: PM-JAY covers not only hospitalization expenses but also includes pre-hospitalization and post-hospitalization costs, such as diagnostics and medicines.
- Inclusive: There are no restrictions on family size, age, or gender, ensuring that everyone in need can benefit from the scheme.
- Pre-existing Conditions: PM-JAY covers pre-existing conditions right from the day of enrollment, providing vital support to those with prior medical conditions.
- Portability: The scheme’s benefits are portable across the entire country, allowing beneficiaries to seek treatment in any empanelled hospital, regardless of their location.
- Extensive Procedure Coverage: PM-JAY includes approximately 1,929 procedures, covering all expenses related to treatment, from medicines to diagnostics to room and surgeon charges.
- Equal Reimbursement: Public hospitals are reimbursed for healthcare services at par with private hospitals, ensuring equitable access to quality care for all beneficiaries.
Ayushman Bharat: Benefit Cover Under PM-JAY
In a departure from previous health insurance schemes in India that featured varying coverage limits, PM-JAY offers a uniform cover of INR 5,00,000 per eligible family annually for listed secondary and tertiary care conditions. This comprehensive coverage encompasses a wide range of services, including medical examinations, pre-hospitalization and post-hospitalization expenses, essential medicines, diagnostics, intensive care services, and more.
The integrated approach of Ayushman Bharat, marked by HWCs and PM-JAY, is poised to address the longstanding healthcare challenges faced by millions in India. By providing financial protection and access to quality healthcare, this initiative represents a significant leap toward achieving the goal of Universal Health Coverage, ushering in a new era in India’s healthcare journey. It stands as a testament to the government’s unwavering commitment to ensuring that no citizen is left behind in the pursuit of good health and well-being.