Ayushman Bharat is a National Health Protection Scheme which has its origin from Aarogyasri Introduced by Andhra Pradesh and Telangana governments.
Aarogyasri (Rajiv Aarogyasri) was a flagship healthcare program of the Government of Andhra Pradesh before the AP Re-organisation in 2014. After the split of the state into Telangana and Andhra Pradesh, Aarogyasri became flagship healthcare scheme of the Government of Telangana and is administered by Aarogyasri Health Care Trust. The new Government of Andhra Pradesh after the state split renamed the scheme in 2014 to Dr. NTR Vaidya Seva and is administered by Dr. NTR Vaidya Seva Trust. It covers those below the poverty line. The government issues an Aarogyasri Card and the beneficiary can use it at the government and private hospitals to obtain services free of cost.
The Programme Aarogyasri Scheme is the flagship scheme of all health initiatives of the State Government with a mission to provide quality healthcare for the poor. The aim of the Government is to achieve “Health for All”. In order to facilitate the effective implementation of the scheme, the State Government set up the Aarogyasri Health Care Trust under the chairmanship of the Chief Minister. A Chief Executive Officer, an IAS Officer, administers the trust. The trust runs the scheme, in consultation with specialists in the field of healthcare.
The beneficiaries of the scheme are the members of Below Poverty Line (BPL) families as enumerated and photographed in White Ration Card linked with Aadhaar card and available in Civil Supplies Department database. Financial coverage (Height of Universal Health coverage): The scheme shall provide coverage for the services to the beneficiaries up to Rs 2.50 lakh per family per annum on a floater basis. There shall be no co-payment under this scheme.
Enrollment
The beneficiaries of the scheme, the members of Below Poverty Line (BPL) families, as enumerated and photographed in BPL Ration Card and available in Civil Supplies Department database.
Extent of Cover
The benefit to the family is on a floater basis i.e. the total reimbursement of Rs 1.50 lakhs can be availed individually or collectively by members of the family. An additional sum of Rs 50,000 is provided as a buffer to take care of expenses if it exceeds the original sum i.e. Rs 1.50 lakhs per family. Excepting cost for cochlear implant surgery with auditory-verbal therapy is reimbursed by the trust up to a maximum of Rs 6.50 lakhs per case.
All transactions are cashless for covered procedures. A BPL beneficiary can go to any hospital either public or private and come out without making any payment to the hospital for the procedures covered under the scheme. The same is the case for diagnostics if eventually, the patient does not end up in undergoing the surgery or therapy.
Hospitals are mandated to conduct free health camp, thereby taking advanced evaluation at the doorstep of the patient.
Point of Contact
All the Primary Health Centers (PHCs) which are the first contact point, area/district hospitals, and network hospitals, are provided with help desks manned by AAROGYA MITHRAs to facilitate the illiterate patients. The Aarogyamithras were selected by the Zilla Samakhyas and Mandal Samakhyas under Indira Kranti Patham (Self Help Groups).
Excluded Treatments
The diseases specifically excluded from the list are high-end diseases such as hip and knee replacement, bone marrow, cardiac and liver transplantations, gamma-knife procedures in neuro-surgery, assisted devices for cardiac failures etc; and diseases covered by national programmes viz., TB, HIV/AIDS, leprosy, infectious diseases,malaria, filaria, gastroenteritis, jaundice, etc.
To the extended RAS covers the treatments, it would no longer be permissible for the BPL holders to apply for relief for medical purposes under Chief Minister Relief Fund (CMRF).
The Ayushman Bharat is a National Health Protection Scheme which will cover over 10 crore poor and vulnerable families (approximately 50 crore beneficiaries) providing coverage up to Rs 5 lakh per family per year for secondary and tertiary care hospitalisation. Ayushman Bharat – National Health Protection Mission — will subsume the on-going centrally sponsored schemes – Rashtriya Swasthya Bima Yojana (RSBY) and the Senior Citizen Health Insurance Scheme (SCHIS).
Salient Features
- Ayushman Bharat – National Health Protection Mission will have a defined benefit cover of Rs 5 lakh per family per year.
- Benefits of the scheme are portable across the country and a beneficiary covered under the scheme will be allowed to take cashless benefits from any public/private impanelled hospitals across the country.
- Ayushman Bharat – National Health Protection Mission will be an entitlement based scheme with entitlement decided on the basis of deprivation criteria in the SECC database.
- The beneficiaries can avail benefits in both public and impanelled private facilities.
- To control costs, the payments for treatment will be done on a package rate (to be defined by the Government in advance) basis.
- One of the core principles of Ayushman Bharat – National Health Protection Mission is to co-operative federalism and flexibility to states.
- For giving policy directions and fostering coordination between Centre and States, it is proposed to set up Ayushman Bharat National Health Protection Mission Council (AB-NHPMC) at apex level Chaired by Union Health and Family Welfare Minister.
- States would need to have the State Health Agency (SHA) to implement the scheme.
- To ensure that the funds reach SHA on time, the transfer of funds from Central Government through Ayushman Bharat – National Health Protection Mission to State Health Agencies may be done through an escrow account directly.
- In partnership with NITI Aayog, a robust, modular, scalable and interoperable IT platform will be made operational which will entail a paperless, cashless
Merits of Scheme
- A Strong Network of 1.5 lakhs Health and Wellness Centers across the country would constitute the foundation of India’s new healthcare systems.
- It will cover more than 10 crore Poor and Vulnerable families of the society.
- The support from trained nurses and health workers increase the availability near home in rural areas.
- Vulnerable sections of the society would have access to healthcare to almost all medical and surgical conditions that can occur in a lifetime.
- Package rates decided by the government for private hospitals would help in keeping the cost low.
- It will generate employment especially for women would help in the economic empowerment of women.
Challenges
- Major Challenge would be Implementation and Governance of the Scheme.
- The private hospitals are based on profitability motives and fixing rates of procedures would increase the chances of hospitals neglecting poor Patients. Healthcare is a goal under SDG 2030 Goal-3 of good health. The scheme would ensure proper healthcare facilities for most vulnerable sections of the society.
- By preventive disease at an early stage can make a change. For example, early detection of diabetes at the age of 35 can avoid kidney failure at the age of 50. Also, schemes exclude outpatient health care that is responsible for 70 per cent of health expenditure.
- Budget allocation of Rs 2,000 crore scheme doesn’t serve the purpose. The amount is meagre as compared to the scope of the scheme.
- The schemes are far from universal health coverage as it excludes 80 crores (60 per cent) of the population.
-By Dr. A. Jagadeesh
Disclaimer: The opinions expressed within this article are the personal opinions of the author. The facts and opinions appearing in the article do not reflect the views of AFTERNOON VOICE and AFTERNOON VOICE does not assume any responsibility or liability for the same.
