Ayushman Bharat Yojana- Details, Objectives & Features

Ayushman Bharat Yojana

The Union Cabinet chaired by the Prime Minister Shri Narendra Modi has approved the launch of a new Centrally Sponsored Ayushman Bharat YojanaNational Health Protection Mission (AB-NHPM) having central sector component under Ayushman Bharat Mission anchored in the MoHFW. The scheme has the benefits cover of Rs. 5 lakh per family per year. The target beneficiaries of the proposed scheme will be more than 10 crore families belonging to poor and vulnerable population based on SECC database. Ayushman Bharat Yojana will subsume the on-going centrally sponsored schemes -Rashtriya Swasthya Bima Yojana (RSBY) and the Senior Citizen Health Insurance Scheme (SCHIS).

Objective

To integrate RSBY into the health system and make it a part of the comprehensive health care vision of Government of India, RSBY was transferred to the Ministry of Health and Family Welfare (MoHFW) w.e.f 01.04.2015 which was launched in the year 2008 by the Ministry of Labour and Employment and provides cashless health insurance scheme with benefit coverage of Rs. 30.000/- per annum on a family floater basis [for 5 members], for Below Poverty Line (BPL) families, and 11 other defined categories of unorganized workers.

During 2016-2017, 3.63 crore families were covered under RSBY in 278 districts of the country and they could avail medical treatment across the network of 8,697 impaneled hospitals. The NHPS comes in the backdrop of the fact that various Central Ministries and State/UT Governments have launched health insurance/ protection schemes for their own defined set of beneficiaries. There is a critical need to converge these schemes, so as to achieve improved efficiency, reach and coverage.


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Features of Ayushman Bharat Yojana

  • Ayushman Bharat Yojana – National Health Protection Mission will have a defined benefit cover of Rs. 5 lakh per family per year.
  • Benefits of the scheme are portable across the country and a beneficiary covered under the scheme will be allowed to take cashless benefits from any public/private impaneled hospitals across the country.
  • Ayushman Bharat Yojana – National Health Protection Mission will be an entitlement based scheme with entitlement decided on the basis of deprivation criteria in the SECC database.
  • The beneficiaries of Ayushman Bharat Yojana can avail benefits in both public and impaneled private facilities.
  • To control costs, the payments for treatment will be done on the package rate (to be defined by the Government in advance) basis.
  • One of the core principles of Ayushman Bharat Yojana – National Health Protection Mission is to co-operative federalism and flexibility to states.
  • For giving policy the directions and fostering coordination between Centre and States, it is proposed to set up Ayushman Bharat National Health Protection Mission Council (AB-NHPMC) at apex level Chaired by Union Health and Family Welfare Minister.
  • States would need to have the State Health Agency (SHA) to implement the scheme.
  • To ensure that the funds reach SHA on time, the transfer of funds from Central Government through Ayushman Bharat Yojana – National Health Protection Mission to State Health Agencies may be done through an escrow account directly.
  • In partnership with NITI Aayog, a robust, modular, scalable and interoperable IT platform will be made operational which will entail a paperless, cashless transaction.
  • One can also visit www.india.gov.in to get detailed information.

Beneficiaries under Ayushman Bharat Yojana

Ayushman Bharat Yojana-NHPM will target about 10.74 crores poor, deprived rural families and identified occupational category of urban workers’ families as per the latest Socio-Economic Caste Census (SECC) data covering both rural and urban. The scheme is designed to be dynamic and aspirational and it would take into account any future changes in the exclusion/ inclusion/ deprivation/ occupational criteria in the SECC data.

Ayushman Bharat Yojana-NHPM will be rolled out across all States/UTs in all districts with an objective to cover all the targeted beneficiaries.

Implementation of Ayushman Bharat Yojana

At the national level to manage, an Ayushman Bharat Yojana – National Health Protection Mission Agency (AB-NHPMA) would be put in place. States/ UTs would be advised to implement the scheme by a dedicated entity called the State Health Agency (SHA). They can either use an existing Trust/ Society/ Not for Profit Company/ State Nodal Agency (SNA) or set up a new entity to implement the scheme. States/ UTs can decide to implement the scheme through an insurance company or directly through the Trust/ Society or use an integrated model.

Major Impact

In-patient hospitalization expenditure in India has increased by nearly 300% during the last ten years. (NSSO 2015). More than 80% of the expenditure is met by out of pocket (OOP). Rural households primarily depended on their ‘household income/savings’ (68%) and on ‘borrowings’ (25%), the urban households relied much more on their ‘income/saving’ (75%) for financing expenditure on hospitalizations, and on ‘(18%) borrowings. (NSSO 2015). Out of pocket (OOP) expenditure in India is over 60% which leads to nearly 6 million families getting into poverty due to catastrophic health expenditures. AB-NHPM will have a major impact on the reduction of Out Of Pocket (OOP) expenditure on the ground of:

  • Increased benefit cover to nearly 40% of the population, (the poorest&the vulnerable)
  • Covering almost all secondary and many tertiary hospitalizations. (except a negative list)
  • Coverage of 5 lakh for each family, (no restriction of family size)

This will lead to increased access to quality health and medication. In addition, the unmet needs of the population which remained hidden due to lack of financial resources will be catered to. This will lead to timely treatments, improvements in health outcomes, patient satisfaction, improvement in productivity and efficiency, job creation thus leading to an improvement in the quality of life.

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