The key components of PMJAY and HWCs under Ayushman Bharat are given below:
Prime Minister Jan Arogya Yojana [PMJAY]
Government of India has launched Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (PMJAY) on 23.09.2018. PMJAY is a centrally sponsored scheme. It is entirely funded by Government and the funding is shared between Center and State governments as per prevailing guidelines of Ministry of Finance.
- PMJAY provides health coverage up to Rs. 5 lakh per family per year for secondary and tertiary hospitalization to around 10.74 crore poor and vulnerable families (approx. 50 crore beneficiaries).
- PMJAY is an entitlement-based scheme. This scheme covers poor and vulnerable families based on deprivation and occupational criteria as per SECC data.
- PMJAY provides cashless and paperless access to services for the beneficiary at the point of service in any (both public and private) empanelled hospitals across India. In other words, a beneficiary from one State can avail benefits from an empanelled Hospital anywhere in the Country.
- Under PMAJY, the States are free to choose the modalities for implementation. They can implement the scheme through insurance company or directly through the Trust/ Society or mixed model.
- There is no restriction on family size, ensuring all members of designated families specifically girl child and senior citizens get coverage.
- At the national level, the National Health Authority (NHA) has been set up to implement the scheme.
- An MoU has been signed between National Health Agency (now National Health Authority) and 33 States/UTs to implement PMJAY.
- About 1393 treatment packages are available for the beneficiaries under PMJAY.
The details of package, operational guidelines and key features are available at www. pmjay.gov.in. More than 1350 packages are available for the entitled beneficiaries of PMJAY. The details of package, operational guidelines and key features are available at www. pmjay.gov.in. The total number of hospitals empaneled under PMJAY is 14,440. Out of these, 7118 are public hospitals. The number of beneficiaries hospitalised under AB-PMJAY are 1,059,693. As on 05.02.2019, 33 States/UTs have signed MoUs with National Health Agency (now National Health Authority), the implementing body for PMJAY. Only States of Telangana, Odisha, and Union Territory of Delhi have not signed the MoU.
Ayushman Bharat – Health and Wellness Centers
In order to expand access to comprehensive primary healthcare (CPHC), under Ayushman Bharat – health and wellness centers (HWCs), sub health centers (SHCs) and primary health centers (PHCs) are being strengthened as health and wellness centers (HWCs). The HWCs are to provide preventive, promotive, rehabilitative and curative care for an expanded range of services encompassing reproductive and child health services, communicable diseases, non-communicable diseases, palliative care and elderly care, oral health, ENT care, and basic emergency care. The services in HWCs will be provided through a mid-level healthcare provider (MLHP)/community health officer (CHO) placed at a HWC-SHC and Medical Officer at PHC (Rural/Urban). The MLHP/CHO will undergo a Certificate in Community Health through IGNOU or public university. The key elements for roll out of CPHC through HWC are as under:
- Expended service delivery
- Continuum of care – tele-health/ referral
- Expanding HR- MLHP & multiskilling
- Medicines & expanding diagnostics
- Community mobilisation and health promotion
- Robust IT system
- Partnership for knowledge & implementation
- Financing/provider payment reforms
While under PMJAY free hospitalization care is being provided to around 10.74 crore families belonging to identified criteria as per SECC database, both rural & urban, under Ayushman Bharat – health and wellness centers (HWCs), comprehensive primary healthcare is being delivered through HWCs covering prevention, promotion and ambulatory care at primary level. The Minister of State (Health and Family Welfare), Ashwini Kumar Choubey stated this in a written reply in the Lok Sabha. – PIB