Context: Nearly 3,000 fraud cases detected under the Ayushman Bharat health insurance scheme.
Relevance:
Prelims: Current events of national and international importance
Mains: GS II-
- Issues relating to development and management of Social Sector/Services relating to Health, Education, Human Resources.
- Welfare schemes for vulnerable sections of the population by the Centre and States and the performance of these schemes; mechanisms, laws, institutions and Bodies constituted for the protection and betterment of these vulnerable sections.
Ayushman Bharat –Pradhan Mantri Jan Arogya Yojana :
Ministry: Ministry of health and family welfare
Ayushman Bharat or “Healthy India” is a national initiative launched to achieve the vision of Universal Health Coverage (UHC).
- It adopts a continuum of care approach, comprising of two inter-related components, which are:
- Establishment of Health and Wellness Centres
- Pradhan Mantri Jan Arogya Yojana (PM-JAY)
Objective: To provide medical coverup to Rs 5 lakh per year per household for secondary and tertiary healthcare.
Intended beneficiary:
- It is a health insurance scheme for BPL families and workers in the unorganized sector.
- Beneficiaries to be identified on the basis of SECC-2011
Features:
- PMJAY provides health cover 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 the SECC database.
- PMJAY provides cashless and paperless access to services for the beneficiary at the point of service in any (both public and private) impaneled hospitals across India. In other words, a beneficiary from one State can avail benefits from an impaneled Hospital anywhere in the Country.
- Under PMAJY, the States are free to choose the modalities for implementation. They can implement the scheme through insurance companies or directly through the Trust/ Society or a mixed model.
- There is no restriction on family size, ensuring all members of designated families specifically girl child and senior citizens get coverage.
- A well-defined Complaint and Public Grievance Redressal Mechanism has been put in place through which complaints/ grievances are registered, acknowledged, escalated for relevant action, resolved and monitored.
- PMJAY has created a robust IT system for the implementation and role of real-time transaction data.
- At the National level, the National Health Authority (NHA) has been set up as an attached office to the Ministry of Health and Family Welfare to manage the implementation of the scheme.
Funding:
PMJAY is a centrally sponsored scheme. It is entirely funded by Government and the funding is shared between Centre and State governments as per prevailing guidelines of Ministry of Finance
