AYUSHMAN
BHARAT – GOVERNMENT SCHEME
News:
Centre urges States,
Union Territories to achieve 100% Ayushman Bharat card saturation
What's
in the news?
● The
Union government has urged all States and Union Territories to achieve 100%
Ayushman Bharat card saturation by utilising the services of grassroots-level
healthcare workers.
Key
takeaways:
● The
Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) is billed as the
largest government-sponsored health insurance scheme in the world.
Ayushmaan
Bharat:
● Launched
as recommended by the National Health
Policy 2017, to achieve the vision of Universal Health Coverage (UHC).
● This
initiative has been designed on the lines to meet SDG and its underlining
commitment, which is “leave no one behind”.
Aims
and Objectives:
● To
accelerate health system preparedness
for immediate responsiveness for early prevention, detection and
management, with a focus on health infrastructure development including for
Paediatric Care and with measurable outcomes.
Benefits:
● It
provides cashless access to health care
services for the beneficiary at the point of service, that is, the
hospital.
● It
envisions to help mitigate catastrophic
expenditure on medical treatment which pushes nearly 6 crore Indians into
poverty each year.
Entitlements:
● Aside
from in-patient treatment expenditures, the system also covers various pre and post-hospitalization charges.
● The
program was planned to provide 1,393 free procedures in accredited public and
private healthcare facilities across 24 specialties.
● Patients
are entitled to cashless care from
empanelled government and private facilities under the initiative.
● Insurance
pay-outs will be based on the government-mandated package pricing for 1,354
diseases.
● However,
to participate in the scheme, a person’s name must be in the SECC database, and
he or she must provide proof of identity (not necessarily Aadhaar).
Achievements:
● More
than 2 crore treatments have been provided to the beneficiary under the scheme.
● More
than 17 crore beneficiaries have been verified through the Beneficiary
Identification System (BIS) and have been provided with Ayushman cards.
● It
has proved to be a boon for women.
● Of
the total number of beneficiaries who have benefited under the scheme, over
half of them are women.
Issues:
1.
Treatment of Dead Patients:
● The
patients earlier shown as “dead” continued to avail treatment under the scheme.
2.
Pensioners Availing Benefits:
● Pensioners
in certain states were found to possess PMJAY cards and were availing treatment
under the scheme.
3.
Unrealistic Household Sizes:
● There
are instances where the registered household sizes were unrealistically large,
ranging from 11 to 201 members
4.
Bogus Mobile Number and Aadhaar:
● It
revealed that some beneficiaries were registered with a single bogus mobile
number, potentially compromising the verification process.
● Some
Aadhaar numbers were linked to multiple beneficiaries, raising questions about
proper verification.
5.
Pending Penalties:
● The
CAG report flagged pending penalties of Rs 12.32 crore from 100 hospitals
across nine states.
WAY
FORWARD:
● Government
hospitals should be removed from the ambit of the scheme as services there are
already free of cost.
● The
government should fund public hospitals directly.
● Under
this scheme, it is being done through insurance companies by paying 15 per cent
to them.
● India
should not continue the insurance route for healthcare delivery as the
administrative cost and the “unholy nexus” with insurance companies point
towards profit maximization rather than quality health care delivery.
● Need
of the hour - “Tax funded” universal health coverage rather than the “for
profit” insurance model.