Ayushman Bharat Yojana

In 2017 an Indian version of the Global Burden of Disease Study reported major diseases and risk factors from 1990 to 2016 for every state in India.[5] This study brought a lot of interest in government health policy because it identified major health challenges which the government could address.[6]

In 2018 the Indian government described that every year, more than six crores Indians were pushed into poverty because of out of pocket medical expenses.[7] There were various available regional and national programs for healthcare in India.

The Indian government first announced the Ayushman Bharat Yogana as a universal health care plan in February 2018 in the 2018 Union budget of India.[8] The Union Council of Ministers approved it in March. In his 2018 Independence Day speech Prime Minister Narendra Modi announced that India would have a major national health program later that year on 25 September, also commemorating the birthday of Pandit Deendayal Upadhyaya.[9] In June 2018 the applications opened for hospitals through an "empanelment process".[8] In July 2018, the Ayushman Bharat Yojana recommended that people access benefits through Aadhaar, but also said that there was a process for people to access without that identity card.[8] AB PM-JAY was launched on 23 September 2018 at Ranchi, Jharkhand.[10]

Around early 2019 sources which called the program "ambitious" include the World Health Organization,[11] Forbes India,[12] Press Trust of India,[13] the Business Standard,[14] and others.[15]

The National Health Protection Scheme (NHPS) scheme is formed by subsuming multiple schemes including Rashtriya Swasthya Bima Yojana, Senior citizen health Insurance Scheme (SCHIS), Central Government Health Scheme (CGHS), Employees' State Insurance Scheme (ESIS), etc. The National Health Policy, 2017 has envisioned Health and Wellness Centres as the foundation of India's health system which the scheme aims to establish.[16]

The scheme envisions to alleviate the condition of 50 crore poor and vulnerable Indians.

On December 26 2020, Prime Minister Narendra Modi launched the Pradhan Mantri Jan Arogya Yojana Sehat (PM-JAY-SEHAT) which extends the Ayushman Bharat scheme to all residents of the Jammu and Kashmir. The scheme will provide a financial cover of Rs. 5 lakh per family for in-patient care and surgical procedures.[17]

Features of PM-JAY include the following:

• Providing health coverage for 10 crores households or 50 crores Indians.[18]
• It provides a cover of 5 lakh per family per year for medical treatment in empanelled hospitals, both public and private.
• Offering cashless payment and paperless recordkeeping through the hospital or doctor's office.[19]
• Using criteria from the Socio Economic and Caste Census 2011 to determine eligibility for benefits.[20][21]
• There is no restriction on family size, age or gender.
• All previous medical conditions are covered under the scheme.
• It covers 3 days of pre-hospitalisation and 15 days of post-hospitalisation, including diagnostic care and expenses on medicines.
• The scheme is portable and a beneficiary can avail medical treatment at any PM-JAY empanelled hospital outside their state and anywhere in the country.[22]
• Providing access to free COVID-19 testing[23][24]

When Ayushman Bharat Yojana began there were questions of how to reconcile its plans with other existing health development recommendations, such as from NITI Aayog.[38] A major challenge of implementing a national health care scheme would be starting with infrastructure in need of development to be part of a modern national system.[38] While Ayushman Bharat Yojana seeks to provide excellent healthcare, India still has some basic healthcare challenges including relatively few doctors, more cases of infectious disease, and a national budget with a comparatively low central government investment in health care.[39]

While many government hospitals have joined the program, many private corporate hospitals have not. The private hospitals report that they would be unable to offer their special services at the government low price, even with a government subsidy.[28]

The scheme has faced challenges in form of fraudulent bills. In response, National Health Authority has revoked empanelment of 171 hospitals and imposed a penalty of 4.6 crore. Another 390 hospitals have been issued show cause notice.[40]

There have been media reports of misuse of the Ayushman Bharat scheme by unscrupulous private hospitals through submission of fake medical bills. Under the Scheme, surgeries have been claimed to be performed on persons who had been discharged long ago and dialysis has been shown as performed at hospitals not having kidney transplant facility.[41] There are at least 697 fake cases in Uttarakhand State alone, where fine of Rs one crore has been imposed on hospitals for frauds under the Scheme.[42] However, unlike the earlier RSBY (Rashtriya Swasthya Bima Yojana) era, plagued by lax monitoring of insurance fraud, AB-PMJAY involves a robust information technology infrastructure overseeing transactions and locating suspicious surges across the country. Health Minister Harsh Vardhan has blacklisted hospitals and named them publicly for misconduct.[43] Initial analysis of high-value claims under PMJAY has revealed that a relatively small number of districts and hospitals account for a high number of these, and some hint of an anti-women bias, with male patients getting more coverage. Despite all efforts to curb foul-play, the risk of unscrupulous private entities profiteering from gaming the system is clearly present in AB-PMJAY.[44]

• Nexdigm (2019). "India's National Health Protection Scheme Ayushman Bharat" (PDF). skpgroup.com. SKP Group.

• Official website