What is Ayushman Bharat? Salient Features of the National Health Scheme

Updated: Wednesday, September 12, 2018, 10:37 [IST]

According to a recent report by the Confederation of Indian Industry (CII) and PWC presented at the CII Health Insurance Summit in Delhi, India only spends 1.25 percent of its GDP on healthcare. It further said that for a country that has an underperforming public health care system, it could benefit greatly if the government managed to effectively implement the Ayushman Bharat-National Health Protection Mission (AB-NHPM).

In his Independence Day address, PM Narendra Modi announced the Pradhan Mantri Jan Arogya Abhiyan, also known as Ayushman Bharat. A pilot program will be initiated in the states of:

Andhra Pradesh
Chandigarh
Chhattisgarh
Daman and Diu
Himachal Pradesh
Haryana
Manipur
Nagaland
Uttarakhand
West Bengal

Out of the 36 states and union territories, 29 have agreed to join the scheme as of now. While six are expected to join in the next month, Odisha has opted out of it.

What is Ayushman Bharat?

It is a National Health Protection Scheme announced in the 2018 Union Budget. It aims to cover around 50 crore beneficiaries from over 10 crore poor and vulnerable families with an insurance coverage of up to Rs 5 lakh per family per year for secondary and tertiary medical care. Ayushman Bharat will subsume Rashtriya Swasthya Bima Yojana (RSBY) and the Senior Citizen Health Insurance Scheme (SCHIS).

Salient Features

Rs. 5 lakh per family per year health insurance benefit cover (irrespective of family size).
Will be launched on 25 September 2018.
Will cover almost 40 percent of the population which will include poor, deprived rural families and identified occupational category of urban workers' families as per the latest Socio-Economic Caste Census (SECC) data (conducted in 2011) covering both rural and urban.
The premium to be paid by the families will be fixed by the State Health Agencies formed for the purpose of the scheme.

Benefits under Ayushman Bharat

1,354 medical and surgical packages under 25 specialty categories such as cardiology, neurosurgery, burns, among others. It also includes oncology with chemotherapy for 50 types of Cancer.
Beneficiaries cannot avail surgical and medical packages at the same time.
Post-hospitalization care is also covered.
For multiple surgeries, the first will be covered with the highest package followed by 50 percent and 25 percent for the second and third respectively.

Medical Expense Coverage

Payments for the treatment will be made on a package rate basis defined in advance by the government.
Beneficiaries can take cashless benefits from any public/private empanelled hospitals anywhere in the country.
For multiple surgeries, the first will be covered with the highest package followed by 50 percent and 25 percent of the expenses for the second and third respectively.
All public hospitals will be included in the scheme from the day of implementation. Out of the private hospitals, over 7,800 hospitals have joined in as of now (around 47 percent of private hospitals in India) according to National Health Agency's data.

Management

A council (National Health Agency) will be set at the apex level chaired by Union Health and Family Welfare Minister will implement Ayushman Bharat.
It will be jointly initiated by state and central government.
State Health Agency (SHA) will be started by the states to implement the scheme to make sure the required IT and other needed infrastructure is formed to identify benefeciaries and print e-cards and provide services.
States/ UTs can decide to implement the scheme through an insurance company or directly through the Trust/ Society or use an integrated model.
Along with NITI Aayog, a robust IT platform will be made operational to entail a paperless, cashless transaction.