Ayushman Bharat Diwas is celebrated all across the nation every year on the 30th of April as the day is significant to help provide and promote affordable medical facilities in the remote parts of the country. This day is of national importance to mark the launch of Ayushman Bharat Yojana, which is also known as Pradhan Mantri Jan Arogya Yojana (PMJAY). It was launched by PM Narendra Modi in the year 2018 to provide various benefits with a cover of 5 lakh rupees per family to be given per year.
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What is Ayushman Bharat?
Ayushman Bharat is a flagship scheme of Government of India which was launched as recommended by the National Health Policy in 2017, to achieve the vision of Universal Health Coverage (UHC). This initiative was taken to meet Sustainable Development Goals (SDGs) and its underlining commitment, which is to “leave no one behind.”
Ayushman Bharat initiative is an attempt by the government to move from sectoral and segmented approach of health service delivery to a comprehensive need-based health care service. This scheme aims to undertake path breaking interventions to holistically address and promote the healthcare system (covering prevention, promotion and ambulatory care) at the primary, secondary and tertiary level in India. Ayushman Bharat initiative is based on a continuum of care approach and is and comprises of two inter-related components, which are –
- Health and Wellness Centres (HWCs)
- Pradhan Mantri Jan Arogya Yojana (PM-JAY)
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Health and Wellness Centres (HWCs)
In February 2018, the Government of India announced the creation of 1,50,000 Health and Wellness Centres (HWCs) by transforming the existing Sub Centres and Primary Health Centres to support this initiative. These centres were modified and renovated to deliver Comprehensive Primary Health Care (CPHC) bringing healthcare closer to the homes of people at primary level. They cover both, maternal and child health services and non-communicable diseases, including free essential drugs and diagnostic services for the people of the nation.
Health and Wellness Centers are well-equipped to deliver an expanded range of services to cater the primary health care needs of the entire population in their area as well as expanding access, universality and equity close to the community. This scheme is launched to emphasis on the health promotion and prevention is designed to bring focus on keeping people healthy by engaging and empowering individuals and communities to choose healthy behaviors over unhealthy ones to keep themselves fit and energetic in order to reduce the risk of developing chronic diseases and morbidities.
Pradhan Mantri Jan Arogya Yojana (PM-JAY)
This is the second component under Ayushman Bharat and is refer as Pradhan Mantri Jan Arogya Yojna or PM-JAY as it is popularly known. This scheme was launched on 23rd September, 2018 in Ranchi, Jharkhand by the Hon’ble Prime Minister of India, Shri Narendra Modi to promote health assurance.
This is the largest health assurance scheme in the world which aims at providing a health cover of Rs. 5 lakhs per family per year for secondary and tertiary care hospitalization to over 10.74 crores poor and vulnerable families (approximately 50 crore beneficiaries) that form a whopping 40% of the Indian population. The households which are included are based on the deprivation and occupational criteria of Socio-Economic Caste Census 2011 (SECC 2011) for rural and urban areas respectively. Earlier PM-JAY was known as the National Health Protection Scheme (NHPS) before being rechristened. The coverage mentioned under PM-JAY, includes families that were covered in RSBY but are not present in the SECC 2011 database. PM-JAY is fully funded by the Government Of India and cost of implementation is shared between the Central and State Governments respectively.
Key Features of Pradhan Mantri Jan Arogya Yojana (PM-JAY)
- It is the world’s largest health insurance/ assurance scheme fully financed by any government.
- It provides a cover of Rs. 5 lakhs per family per year for secondary and tertiary care hospitalization for poor people of the nation.
- Over 10.74 crore poor and vulnerable entitled families are eligible for these benefits under this scheme.
- PM-JAY allows the cashless access to health care services for the beneficiary at the point of service, that is, the hospital or any healthcare Centre.
- PM-JAY aims is to help mitigate catastrophic expenditure on medical treatment due to which nearly 6 crore Indians went into poverty each year.
- It covers up to 3 days of pre-hospitalization and 15 days post-hospitalization expenses such as diagnostics and medicines in the hospital in India.
- There is no as such restriction on the family size, age or gender.
- All pre–existing conditions are covered from day one and all the benefits are provide from first day.
- Benefits of the scheme are applicable all over the nation and a beneficiary can visit any empanelled public or private hospital in India to avail cashless treatment.
- Services under this scheme include approximately 1,393 procedures covering all the costs related to treatment, including but not limited to drugs, supplies, diagnostic services, physician’s fees, room charges, surgeon charges, OT and ICU charges etc.
- Public hospitals are reimbursed for the healthcare services at par with the private hospitals to provide the treatment to the people.
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Benefits Cover Under PM-JAY
PM-JAY allows the cashless cover of up to INR 5,00,000 to each eligible family per annum for listed secondary and tertiary care conditions all across the nation and the services under this scheme are portable. The cover under the scheme includes almost all expenses which are incurred on the following components of the treatment.
- Medical examination, treatment and consultation
- Medicine and medical consumables
- Non-intensive and intensive care services
- Diagnostic and laboratory investigations
- Medical implantation services (where necessary)
- Accommodation benefits
- Food services
- Complications arising during treatment
- Post-hospitalization follow-up care up to 15 days
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The benefits of INR 5,00,000 are given to a family under which it can be used by one or all members of the family. This scheme has been designed in such a way that there is no cap on family size or age of members or is not restricted to certain gender. In addition, pre-existing diseases are covered from the very first day and all the expenses are covered under this scheme.