Dr R S Sharma Chief Executive Officer, National Health Authority

The National Health Policy (NHP) of 2017 had listed among its foremost objectives, the achievement of Universal Health Coverage. Achieving a significant reduction in out of pocket expenditure due to health care costs was another key objective. Ayushman Bharat Pradhan Mantri – Jan Arogya Yojana (AB PM-JAY) was conceived out of this vision to move towards a more holistic approach to healthcare service delivery.

Ayushman Bharat PM-JAY was not the nation’s first tryst with healthcare insurance. Due credit must be given to predecessor schemes such as Rashtriya Swasthya Bima Yojana (RSBY), States schemes like Aarogyasri in Andhra Pradesh, Jeevandayee Yojana in Maharashtra. However, in terms of scope and scale, AB PM-JAY simply dwarfed all existing healthcare insurance interventions. It is for the first time that we now have a health insurance scheme with a pan-India presence being implemented almost everywhere in the country.

As of 01^st April 2022, Ayushman Bharat PM-JAY in alliance with State health schemes covers a beneficiary base of more than 14 Crore families (70 Crore individuals). Almost 18 Crore individuals have been identified under the scheme and provided with an Ayushman card. AB PM-JAY has facilitated almost 3.28 Crore hospitalizations providing treatment worth over Rs. 37,600 Crores. All this has been achieved in a little over 3.5 years and amidst the greatest global pandemic in recent times.

As I reflect on the trajectory of Ayushman Bharat PM-JAY, the scheme’s success is mounted on the vision of the Hon’ble Prime Minister and the versatile policy framework conceptualized by the Cabinet. This policy framework crystallized the guiding principles behind Ayushman Bharat PM-JAY which are as follows:

Comprehensive healthcare benefits

AB PM-JAY was launched with 1,393 treatment packages covering treatment for various medical specialties like oncology, neurosurgery, cardiovascular surgery, etc up to Rs. 5 Lakhs per beneficiary family. This was subsequently increased to 1,670 treatment packages. The benefits package under AB PM-JAY was comprehensive covering pre and post hospitalisation expenses. Additionally, all pre-existing conditions were covered from day one of the policy periods. The portability feature empowered beneficiaries from the remotest villages to seek treatment at the most advanced healthcare facilities.

Converged and integrated within the healthcare ecosystem

Under AB PM-JAY considerable flexibility was provided to the States and Union Territories (UTs) in choosing their mode of implementation, beneficiary database, and creation of the network of hospitals. Further, NHA diligently pursued convergence with the existing State based schemes. Currently, AB PM-JAY is implemented in alliance with more than 25 State-specific health schemes. Additionally, District Implementation Units were set up in over 600 districts across the country to ensure that the administrative reach of AB PM-JAY to the beneficiary’s doorstep.

Ensuring equity in access to healthcare services

Renewed impetus has been given to extending the scheme benefits to the marginalized sections of society covered under the Socio-Economic Caste Census database. Likewise, AB PM-JAY has adopted an enlightened approach toward ensuring gender-specific equity. The erstwhile RSBY scheme had mandated a limit of adding up to 5 family members. Unfortunately, this led to the exclusion of female members of the household, especially the girl child. However, under AB PM-JAY, this capping was done away with. Women account for approximately 50% of Ayushman cards generated using the NHA IT platform and 47% of authorized hospital admissions.

Robust, scalable, and inter-operable technology platforms

One of the problems that afflicted in the past was fragmented IT systems for the schemes like Ayushman Bharat PM-JAY. Therefore, under AB PM-JAY, a highly versatile technology platform was developed to aid in beneficiary identification, transaction management, and hospital empanelment. This award-winning IT platform is now active across 26 States and UTs. As a result, SHAs and NHA have gained granular insights into the scheme to aid in evidence-based policymaking and necessary course correction, where required.

Public and private partnership

Under Ayushman Bharat PM-JAY both public and private hospitals have been empanelled for providing healthcare services to the scheme beneficiaries. The participation of the private sector has increased avenues for the scheme’s beneficiaries to seek treatment and concurrently reduced the burden on tertiary care facilities in the public sector. Under AB PM-JAY, it was ensured that public hospitals would be equally reimbursed for their services and at the same rates as that of private hospitals. This has also supported public sector hospitals to create a pool of untied funds that could be sustainably invested in infrastructure and human resources. The complementary role of the public and private sector hospitals has been vital in ensuring that the scheme implementation proceeded seamlessly.

Aapke Dwar Ayushman

One of the key activities that I green-lighted upon assuming charge of NHA was the “Aapke Dwar Ayushman”. Under Aapke Dwar Ayushman, a grassroots network of frontline healthcare workers, Gram Panchayat officials, and village-based digital entrepreneurs were used to undertake door-to-door mobilization of beneficiaries across communities. Special night camps were set up for daily wagers. These efforts translated into the creation of more than 4.7 Crore Ayushman cards since January 2021, an increase of 55% in the Ayushman cards generated by NHA IT system. NHA is launching Aapke Dwar Ayushman with renewed vigour. This time we are focusing on States such as Assam, Bihar, Gujarat, and Uttar Pradesh.

Aside from this, I would also like to take this opportunity to give credit to the entire Ayushman Bharat PM-JAY ecosystem consisting of NHA, SHAs, DIUs, Implementation support agencies, Pradhan Mantri Arogya Mitras, frontline healthcare workers, Ayushman card creators from partner agencies such as CSC / UTIITSL for their tireless support in making AB PM-JAY such a grand success. However, going forward much more needs to be done to help the scheme realize its full potential.

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