Ayushman Bharat: All You Need to Know About the New Health Scheme

Prime Minister Narendra Modi rolled out the Centre’s flagship Ayushman Bharat-National Health Protection Mission (AB-NHPM) from Jharkhand’s Ranchi on Sunday, 23 September.

(Photo: The Quint/Shruti Mathur)

Prime Minister Narendra Modi on Sunday, 23 September, rolled out the Centre’s flagship Ayushman Bharat-National Health Protection Mission (AB-NHPM) from Ranchi, in Jharkhand. The scheme will become operational from 25 September on the birth anniversary of Pandit Deendayal Upadhya, and will reportedly be funded on a 60:40 ratio by the centre and state government.

Stated to be the largest healthcare scheme in the world, Ayushman Bharat aims to provide a coverage of Rs 5 lakh per family annually, benefiting more than 10.74 crore poor families.

In addition to the insurance plan, the government aims to open 1.5 lakh health and wellness centres by 2022, which would be equipped to treat diseases including blood pressure, diabetes, and cancer. Ten such health and wellness centres in the state were inaugurated in Jharkhand on Sunday.

“The goal is to prepare a half lakh such centres all over the country in the next four years,” PM Modi said in his speech.

Who are the Beneficiaries?

The scheme will target poor, deprived rural families and identified occupational category of urban workers' families, ie 8.03 crore in rural and 2.33 crore in urban areas, as per the latest Socio-Economic Caste Census (SECC) data.

Around 50 crore people will be covered in all.

Secondary and tertiary care hospitalisation will be provided through a network of Empanelled Health Care Providers.

Additionally, there is a provision for cashless and paperless access to services for the beneficiaries at the point of service. This will help reduce expenditure for hospitalisation, which impoverishes people, and will help mitigate the financial risk arising out of catastrophic health episodes.

Nearly 5.5 crore people were pushed below the poverty line because of healthcare expenses, BloombergQuint stated citing a Public Health Foundation of India report from May. Of this number, 3.8 crore became poor only because they had to bear medicine costs, the report states. The scheme primarily targets these families.

Entitlement Decided Through SECC Data

The entitlement will be decided on the basis of deprivation criteria in the Socio-Economic Caste Census (SECC) database, PTI reported. The beneficiaries are identified based on the deprivation categories identified under the SECC database for rural areas. For the urban areas, the 11 occupational criteria will determine entitlement.

There is no cap on family size and age in the scheme, ensuring that nobody is left out. One would only need to establish one’s identity to avail benefits under the scheme and it could be through Aadhaar card or election ID card or ration card. Having an Aadhaar card is not mandatory.

In case of hospitalisation, members of the beneficiary families do not need to pay anything under the scheme, provided one goes to a government or an empanelled private hospital.

“Expenses up to five lakhs are included in the scheme, and apart from expenditure incurred in the hospital, checks, medicines, expenses before recruitment and the cost of treatment till completion are also included. If someone has any prior illness then the cost of the disease will be raised by this scheme.”

Narendra Modi, Prime Minister

Subsidised Rates Promised

The Health Ministry has included 1,354 packages in the scheme under which treatment for coronary bypass, knee replacements and stenting, among others, would be provided at 15-20 percent cheaper rates than the Central Government Health Scheme (CGHS).

So far 15,686 applications for hospital empanelment have been received and over 8,735 hospitals, both public and private, have been empanelled for the scheme.

‘Ayushman Mitra’ to Assist Patients

The National Health Agency (NHA), the apex body implementing the AB-NHPM, has launched a website and a helpline number to help prospective beneficiaries check if their name is there in the final list.

One can visit mera.pmjay.gov.in or call up the helpline (14555) to check their enrolment. A beneficiary needs to key in his or her mobile number, which is verified through an OTP and then complete the KYC (know your customer) online without any need for human interface with other documents.

Each empanelled hospital will have an ‘Ayushman Mitra’ to assist patients and will coordinate with beneficiaries and the hospital. They will run a help desk, check documents to verify the eligibility and enrolment to the scheme.

All the beneficiaries will be given letters having QR codes which will be scanned and a demographic authentication conducted for identification and to verify his or her eligibility to avail the benefits of the scheme.

What are the Caveats?

In June, the biggest body of doctors, Indian Medical Association, had found pricing of procedures under the healthcare scheme inadequate.

“The rates are far too low to provide quality treatment to patients”, Vinod Kumar Monga, honorary finance secretary at IMA, told BloombergQuint. The cost structure is “humanly impossible” for doctors to offer treatment that otherwise is much more expensive, he said. He added that the system should be made viable for everyone to work “enthusiastically”.

So the question is if it will achieve the intended goals.

5 States Opt Out of Ayushman Bharat Scheme

Following the launch of the PMJAY, the Telangana government announced that it has decided not join the scheme 'as of now' and would continue to implement its health scheme, official sources told PTI.

“One of the reasons for not joining it for the time being is that the state’s Aarogyasri scheme covers nearly 80 lakh families.”

An official to PTI

As many as 30 states and Union Territories have signed MoUs with the Centre and will implement the programme over the next two to three months.

Remaining states and UTs, which include Odisha, Delhi, Kerala and Punjab have not signed, so the scheme will not be implemented there till they come on board.

According to NDTV, Odisha CM Naveen Patnaik too opined that the state-funded health scheme was far more effective than the PMJAY, as it offered cover of Rs 7 lakh, as opposed to the Centre’s Rs 5 lakh.

Meanwhile, speaking to the Indian Express, Kerala state finance minister Thomas Issac said the scheme was a “big hoax”, as it offered “big jumps for a low premium.”

“The subsidy ceiling for the current RSBY scheme of Rs. 30,000 benefit is Rs. 1,250. The subsidy for the Ayushman scheme, with benefits of Rs. 5 lakh, is Rs. 1,110. Is it possible to have such a jump in benefits for lower premium?”

Thomas Isaac

According to the NDTV report, the Delhi government expressed its reservations with the scheme, stating that the provisions would benefit around 6 lakh people – a mere 3 percent of its population.

(With inputs from PTI, BloombergQuint)