AYUSHMAN BHARATH PRDHAN MANTRI JAN AROGYA YOJANA

SYNOPSIS :
1.Introduction
2.Histroy
3.Features
4.Implementation
5.Challenges

INTRODUCTION :
Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (abb. AB PM-JAY,
translation: Longeval India Prime Minister's People's Health; also referred to
as Ayushman Bharat National Health Protection Scheme abb. NHPS) of
the Government of India is a national health insurance scheme of the state that aims to
provide free access to healthcare for low income earners in the country. Roughly, the
bottom 50% of the country qualifies for this scheme. [2] People using the program access
their own primary care services from a family doctor. When anyone needs additional care,
then PM-JAY provides free secondary health care for those needing specialist treatment
and tertiary health care for those requiring hospitalization.[3]

Urban Primary Health Centre Ayushman Bharat Bidipeth Nagpur

The programme is part of the Indian government's National Health Policy and is means-
tested. It was launched in September 2018 by the Ministry of Health and Family Welfare.
That ministry later established the National Health Authority as an organization to
administer the program. It is a centrally sponsored scheme and is jointly funded by both
the federal government and the states. By offering services to 50 crore (500 million) people
it is the world's largest government sponsored healthcare program.[4] The program is
a means-tested as its users are people with low income in India.
 AYUSHMAN BHARATH PRDHAN MANTRI JAN AROGYA YOJANA

HISTROY :
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] Despite various available regional and national programs for healthcare in India,
there was much more to be done. The Indian government first announced the Ayushman
Bharat Yojana 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]
PM-JAY stamp
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 first launched on 23 September 2018
at Ranchi, Jharkhand.[10] By 26 December 2020 the scheme was extended to the Union
Territories of Jammu Kashmir and Ladakh.[11] The program has been called "ambitious".[12][13]

FEATURES :
Features of PM-JAY include the following— providing health coverage for 10 crores
households or 50 crores Indians;[14] providing a cover of ₹5 lakh (US$7,000) per family
per year for medical treatment in empaneled hospitals, both public and private;
offering cashless payment and paperless recordkeeping through the hospital or doctor's
office;[15] using criteria from the Socio Economic and Caste Census 2011 to determine
eligibility for benefits;[16][17] 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;[18] providing access to free COVID-19 testing.[19][20]
 AYUSHMAN BHARATH PRDHAN MANTRI JAN AROGYA YOJANA

IMPLEMENTATION :
Participation by states and union territories
India's 28 states and 8 union territories each make their own choice about whether to
participate in Ayushman Bharat Yojana.[8] In February 2018 when the program was
announced 20 states committed to join.[8] In September 2018 shortly after launch some
states and territories declined to participate in the program.[21] Maharashtra and Tamil Nadu
initially declined to join because they each had their own state healthcare
programmes.[22][23] Those programs, Mahatma Jyotiba Phule Jan Arogya Yojana and the
programme for Tamil Nadu, were already functioning well. These states later both joined
Ayushman Bharat Yojana with special exceptions to make it part of their existing
infrastructure.[23] In a similar way, Kerala, despite having its own health program agreed to
begin using Ayushman Bharat Yogana from November 2019. [24][25] West Bengal initially
joined the program but then opted out in favor of establishing their own regional health
programme.[26] Telangana did the same.[27] By January 2020 Odisha had not joined the
scheme.[28] In March 2020 Delhi announced that it would join the program. [29]
Participation by local people
In May 2020 Prime Minister Narendra Modi said in his radio show Mann Ki Baat that the
Ayushman Bharat scheme had recently benefited more than one crore people. [30] By May
2020, the scheme had provided more than 1 crore treatments with a value
of ₹13,412 crore.[31] The number of public and private hospitals empanelled nationwide
stands at 24,432.[32] The Ayushman Bharat Yojana programme announced a special
collaboration with the Employees' State Insurance programme in November 2019.[33] From
June 2020, the program had entered a pilot to cover 120,000 workers with that insurance at
15 hospitals.[34]

CHALLENGES :
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.[35] 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.[35] 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. Some of the problems lay
outside the Health Ministry such as urban development or transport. [36] 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.[23]
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 (US$640,000). Another 390 hospitals have been issued show cause notice.[37]
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. [38] There are
AYUSHMAN BHARATH PRDHAN MANTRI JAN AROGYA YOJANA

at least 697 fake cases in Uttarakhand State alone, where fine of ₹1 crore (US$140,000) has
been imposed on hospitals for frauds under the Scheme.[39] 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. [40] 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.[41]

NAME : DHINUSHREE M
REGIMENTAL NO: TNSW20/A761229
INSTITUTION : ANNA UNIVERSITY , TIRUCHIRAPALLI
UNIT : 2 TNBN NCC
GROUP : TIRUCHIRAPALLI
AYUSHMAN BHARATH PRDHAN MANTRI JAN AROGYA YOJANA