“The Government of India is committed to Universal Health Coverage (UHC) and through our Ayushman Bharat(Long Live India) Scheme we are well on our way to achieve it by reducing inequalities in access to inpatient care, reducing the incidence of catastrophic health expenditures, and improving access and quality of health services in the public and private sectors. I am happy to announce that in a short period of time, under the Ayushman Bharat scheme, more than 21,000 Health & Wellness Centers have become operational and in the first year since its launch, about 4.7 million (47 lakh) people have availed of treatments under its Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) pillar which provides health assurance cover to the most needy people of the country”. This was stated by Dr Harsh Vardhan, Union Minister of Health and Family Welfare during his interaction with the media at the Foreign Correspondents’ Club in New Delhi to mark the successful completion of one year of the Ayushman Bharat-PMJAY scheme.
Dr Harsh Vardhan further stated that Ayushman Bharat is the vision of the Hon. Prime Minister Narendra Modi ji to provide health care to the poor and vulnerable Indians, who need it the most. The Union Health Minister quoted Hon. Prime Minister Narendra Modi who had said that “Ayushman Bharat scheme is going to transform the health sector. It will provide top quality healthcare to the poor”. He further stated that in designing and implementing this scheme, India has drawn from the experience of other middle-income countries that have undertaken major health financing reforms towards achieving universal health coverage and the Sustainable Development Goal (SDG) 3.8 related to UHC.
Highlighting the scheme, Dr Harsh Vardhan stated that it is probably the biggest public healthcare initiative in the world. While the 1.5 lakh Health and Wellness Centres (to be operationalised by December 2022) provide comprehensive primary care (CPHC) including preventive and promotive healthcare close to the communities, PMJAY covers about 550 million poor and vulnerable Indians. It provides a health assurance cover over USD 7000 (INR 500,000) per family per year for secondary and tertiary care for serious and catastrophic illnesses. PMJAY provides cashless and paperless access to services for the beneficiary at the point of service.
Dr Harsh Vardhan further stated that this year, as we complete one year of launch of Ayushman Bharat PM-JAY scheme, about 4.7 million people have availed of treatments worth over USD 1070 million (INR 75000 million). Of the total amount utilised, 55 percent has been on tertiary procedures that were not covered under the predecessor scheme that primarily focused on secondary care. In addition, more than 102 million beneficiary cards have been issued Dr Harsh Vardhan further stated that under PMJAY, nearly 18,100 hospitals have been empanelled across the country. Of this, 53% of the hospitals empanelled are private, especially multi-specialty, and 62% of the treatments have been in these private hospitals. A unique feature of PMJAY is its portability, which has helped the eligible poor and migrant workers to seek treatment outside their states. So far, there have been more than 40,000 portability cases, he informed.
Dr Harsh Vardhan informed the foreign correspondents that Ayushman Bharat PMJAY will create the world’s best health assurance program on an efficient and technologically robust eco-system, and thus ensure financial protection against catastrophic health expenditure and access to affordable and quality healthcare for all. PMJAY is the world’s largest fully Government funded health insurance scheme. India has chosen to fund Ayushman Bharat PMJAY exclusively from general government revenues, without any contributions from the population, an approach adopted by several countries including Mexico, Thailand and Turkey. He said that as on date, 32 States and Union Territories are implementing Ayushman Bharat PMJAY. In the true spirit of cooperative federalism, NHA and States have worked with a strong partnership approach. Keeping in mind variations across the States, a lot of flexibility has been built in the Ayushman Bharat PMJAY design, and the scheme provides a lot of flexibility to States in terms of scheme design and implementation.
The Union Health Minister added that recently the Governing Board of the National Health Authority (NHA) decided to overhaul the existing health benefits packages and rationalize the cost of the packages to remove any aberrations. This will ensure wider private sector participation by empanelling more hospitals to improve access to hospitalization related care. We also approved an upgrade to our IT system to make it even more user-friendly, interoperable, secure and state-of-the-art, he stated. Initiatives for improving the quality of services were also endorsed, Dr Harsh Vardhan said.
The Union Health Minister mentioned that the entire backbone of the scheme lies with maintaining the security and privacy of beneficiaries’ personal and sensitive personal data, such as Aadhaar information, personal health records, financial information etc. He added that Ayushman Bharat PM-JAY has a well-designed, robust and multilayered security system with the appropriate application of the best available technology as per the international standards to holistically safeguard the Health Information of its beneficiaries and NHA is currently building PM-JAY 2.0, the new and upgraded IT ecosystem of Ayushman Bharat PMJAY.
“NHA has a comprehensive anti-fraud policy that draws on global and national experiences including six country (U.S, Indonesia, Philippines, Turkey, Korea and Croatia) case studies and four Indian state case studies (Maharashtra, Gujarat, Tamil Nadu, and Telangana). Ayushman Bharat PMJAY is being governed on a zero-tolerance approach towards any kind of fraud, and the anti-fraud framework rests on three key pillars of prevention, detection and deterrence. A total of 97 errant hospitals have been de-empanelled and penalties worth more than USD 214000 or INR 15 million have been levied”, Dr Harsh Vardhan said. He added that NHA has recently launched an initiative of quality certification standards and a process for digital quality certification for Ayushman Bharat PMJAY empanelled hospitals which will be an independent exercise carried out by Quality Council of India. Keeping in mind the poor and vulnerable beneficiaries, Ayushman Bharat PMJAY has a holistic beneficiary empowerment system, which is implemented via call centre, auto SMS, PMJAY website, self help portal, Central Grievance Redressal System, Prime Minister’s letter, PM-JAY mobile app. “The website and call centre with toll-free helpline no. 14555 have significantly helped in guiding patients to seek healthcare as well as to send their feedback and grievances for timely redressal. On an average, three calls are being answered every minute at the call centre”, the Health Minister mentioned.
Elaborating further, Dr Harsh Vardhan stated that in the long run, the Ayushman Bharat PMJAY, through its system of incentives, aims to expand the availability of services. With greater demand, the private sector is likely to expand in the unserved areas of Tier-2 and Tier-3 cities. For public hospitals, PMJAY provides incentives to prioritise poor patients and provides means to generate additional revenue for strengthening their infrastructure and fill their service delivery gaps. “This will give a thrust towards achieving the commitment to UHC. We are aware that the road to UHC is a long journey, and we are taking stock of global lessons and learning from experiences in other countries to continuously reform our approach,” he stated.
The Union Health Minister also stated that to mark the first year anniversary of Ayushman Bharat PM-JAY, the National Health Authority is organizing a 2-day national workshop, Arogya Manthan, on September 30th and October 1st, 2019. In the Arogya Manthan, all important stakeholders of PMJAY will meet and discuss through day-long sessions and working groups to come up with implementable solutions to the challenges faced in the past year in the implementation of the scheme and to forge new understanding and pathways towards improving implementation.
Informing about the primary pillar of Ayushman Bharat, Dr Harsh Vardhan stated that through more than 21,000 AB-HWCs, the service area population [around 50 million (5 crore) population empanelled to these centres] are getting out patient service besides the assured maternal and child healthcare services and management of common ailments through newly posted, trained and appropriately oriented Community Health Officers (CHOs). The operational AB-HWCs have a footfall of 1,70,63,522 patients till date. He stated that AB-HWCs will help to provide an enabling environment to increase the health seeking behaviour of the poor people; contribute towards reducing the out of pocket expenditure of the common people; create an assured system of continuum of care model (well-defined referral chain); help in increasing the trust of the people on the service provision by public healthcare facilities through health system strengthening and improvement; and enhance awareness to the people on preventive and promotive healthcare, yoga, healthy lifestyle and eat right & eat safe etc.
Further elaborating on the benefits that have accrued from the AB-HWCs, the Health Minister stated that more than 15 million (1.5 Crore) population is screened for hypertension and more than 7 million (70 lakhs) people are put on treatment; similarly, around 13 million (1.3 crore) population are screened for Diabetes and more than 3.1 million (31 lakhs) people are on treatment. Similarly, for suspected cases for the three common cancers (breast, cervix and oral), they are referred to the higher public healthcare facilities for diagnosis and treatment. He added that more than 7.6 million (76 lakhs) population is screened for oral cavity cancer and out of these, 10,218 people are on treatment. While more than 5.3 million (53 lakhs) women is screened for breast cancer and around 9700 women are on treatment, more than 3.7 million (37 lakhs) women is screened for cervical cancer and around 10000 women are on treatment. In addition, more than 16 million (1.6 Crores) have been provided medicines and around 4.9 million (49 lakhs) population are provided diagnostic services. Dr Harsh Vardhan also informed that tele-consultation services to the people with the qualified medical officers and specialists for cases referred from Sub Health centre level and PHC level respectively will be introduced shortly. A pilot is being done with eSanjeevani application of C-DAC, Mohali in Gujarat; after the due security audit, it will be rolled out in all functional AB-HWCs in phased manner. – MB Bureau