Ayushmaan Bharat Yojana (PM Jan Aarogya Yojana)

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Concerned Ministry: Ministry of Health and Family Welfare.

Financing: Centrally sponsored scheme

THEME AND KEY FEATURES

  • The scheme aims at making interventions in the primary, secondary and tertiary health care systems and ensuring coverage of preventive as well as promotive health.
  • Ayushman Bharat Yojana is an umbrella scheme encompassing two major health initiatives:
  1. Health & Wellness Centres:
    • 1.5 lakh new wellness centres(HWC) have been planned to provide comprehensive health care (this includes non-communicable diseases, maternal and child health services, free essential drugs and diagnostic services).
    • SHCs and PHCs are being strengthened as Health and Wellness Centres (HWC). HWC will provide preventive, promotive, rehabilitative and curative care for an expanded range of services.
    • The list of services to be provided at the health and wellness centre include:
      • Pregnancy care and maternal health services
      • Neonatal and infant health services
      • Child health
      • Family planning, contraceptive services and other reproductive Health care services.
      • Chronic communicable diseases
      • Non-communicable diseases
      • Care for common ophthalmic and ENT problems
      • Basic Oral health care
      • Management of mental illness
      • Geriatric care Emergency medicine
      • Emergency Medical Services
    • Salient Features
      • Expanded Service Delivery
      • Continuum of Care – Telehealth/Referral
      • Expanding HR – MLHP and Multiskilling
      • Medicines & Expanding Diagnostics
      • Community Mobilisation and Health Promotion
      • Robust IT System
      • Infrastructure
      • Partnership for Knowledge & Implementation
      • Financing/Provider Payment Reforms.
    • Hierarchy of HWC
      • States will also have the flexibility to expand the service package to address problems of local importance as defined by disease prevalence and community feedback.
      • In the urban area, the Urban Primary Health Centres (PHC) or Urban Health Posts where they exist, would be strengthened to deliver comprehensive primary health care.
      • One Multipurpose worker per 10,000 population supported by four-five ASHAs, will enable outreach services, preventive and promotive care and home and community-based services and will be the first point of the referral being the UPHC.
      • First 'health and wellness centre' has been inaugurated in Bijapur district in Chhattisgarh.
  1.  
  2. National Health Protection Scheme (NHPM):
    • 10 crore poor and vulnerable families (50 crore people) will be covered by providing a coverage of Rs. 5 lakhs for secondary and tertiary care hospitalization (on the basis of latest Socio-Economic Caste Census).
    • Cashless benefits from any public or private empanelled hospitals with portability across the country for the beneficiaries. PMJAY has defined 1350 medical packages covering surgery, medical and daycare treatments including medicines, diagnostics and transport.
    • Funding: 60:40 Centre: States and 90:10 for North Easter and Hilly states.
    • No cap on family size and age.
    • All pre-existing diseases are covered. Hospitals cannot deny treatment.
    • States: States are free to join the scheme. Some states such as Telangana, Punjab, Odisha etc have opted out of the scheme.
    • States can choose the model of scheme implementation:
      • Insurance Model: Premiums are paid to the insurance company, which administers and pays the claim.
      • Trust-based Model: Each state forms its own trust to manage the scheme and claims will be disbursed from a corpus created from Central and State government contributors.
      • Hybrid Model: A part of the claims comes under the insurance model while the balance gets processed under the trust.

NATIONAL HEALTH AUTHORITY

  • The National Health Agency which was the nodal agency to run the PMJAY has been restructured into National Health Authority for better implementation of PMJAY.
  • National Health Authority is an attached office to MOHFW.
  • The Governing Board of the National Health Authority will be chaired by Union Minister in charge of MOHFW.
  • States will also be represented in the Governing Board on a rational basis.



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