Ayushman Bharat: Features, Eligibility, and More

Fundamentally a National Health Protection Scheme, Ayushman Bharat is Modi government’s most popular health initiative instituted for the people of the country. Under Ayushman Bharat, more than 50 crore beneficiaries (more than 10 crore families) will receive a Rs.5 lakh coverage each for tertiary and secondary care hospitalisation. Additionally, Ayushman Bharat will also subsume the existing health schemes sponsored by the Central. These schemes include Rashtriya Swasthya Bima Yojana (RSBY) and Senior Citizen Health Insurance Scheme (SCHIS).

What is the Implementation Strategy of Ayushman Bharat?

After days and months of planning and analysing, the Modi Government finally launched the much-anticipated Ayushman Bharat on 15 August 2018. However, establishing a health insurance scheme on a national level is not an easy task to accomplish, especially for a country like India. The Modi Government undertook the following strategy to successfully implement Ayushman Bharat in the rural and urban areas of India:

  • An Ayushman Bharat National Health Protection Mission Agency (AB-NHPMA) has been established to handle the implementation of the scheme on a national level.
  • For Indian states and union territories, State Health Agencies (SHAs) have been established to implement the scheme and assist people in a comprehensive manner. Furthermore, instituted new State Health Agency (SHA) could either be a completely new entity or it could be an already existing trust or an NGO, or a not-for-profit organisation.
  • The union territories and states can also carry out the implementation procedure through an established insurance company, or make use of an integrated model.

What are Salient Features of Ayushman Bharat National Health Protection Mission?

Some of the salient features of ‘Modicare’ are mentioned below:

  • Ayushman Bharat invariably provides Rs.5 lakh coverage per family every year to more than 10 crore families spread across India.
  • The scheme’s benefits are portable all throughout India and all beneficiaries who have signed up for Ayushman Bharat will be able to avail cashless treatments from any empanelled hospital - be it a private entity or a public hospital.
  • Ayushman Bharat or Modicare is essentially an entitlement-oriented scheme, wherein the factor of entitlement will be determined according to the deprivation criteria in the database of SECC.
  • Both private as well as public hospitals have been empanelled to carry out procedures in Ayushman Bharat.
  • To promote cost control, each beneficiary’s treatment will be paid for based on a certain package rate which the Government of India will predetermine.
  • Ayushman Bharat has adopted the principles of thorough flexibility and cooperative federalism across all states and union territories of India.
  • Ayushman Bharat National Health Protection Mission Council (AB-NHPMC) will be established at the apex level in order to foster effective communication and coordination between the States and the Centre. This body will be governed by the Union Health and Family Welfare Minister.
  • State Health Agencies (SHA) are a prerequisite for Indian states to implement the scheme.
  • An escrow account will be made use of in order to conduct successful transaction of funds to the State Health Agencies (SHAs).

What is the Eligibility Criteria of Ayushman Bharat - National Health Protection Mission?

The eligibility criteria pertaining to urban areas have been mentioned below:

  • Ragpickers and beggars
  • Domestic workers
  • Hawkers, street vendors, and cobblers. Multiple other people who provide different types of services on the streets will also be included
  • Repair work and construction workers
  • Electricians and mechanics
  • Assemblers
  • Masons, labours, welders, painters, security guards, other head-load workers
  • Peon appointed in small-scale establishments
  • Shop workers and assistants
  • Delivery assistants and waiters
  • Automobile drivers and conductors
  • Rickshaw and cart pullers
  • Sanitation workers
  • Sewage cleaners
  • Gardeners
  • Sweepers
  • Washermen and washerwomen
  • Chowkidars
  • Handicrafts workers
  • Home-based domestic workers

The eligibility criteria pertaining to rural areas have been mentioned below:

  • Family members of manual scavengers
  • ST/SC households
  • Legally-emancipated bonded laborers
  • Families that live in a single room having ‘kacha roof and kacha walls’
  • Primitive tribal groups based in villages and beyond
  • Families that have at least one member who is physically challenged and no able-bodied adult members
  • Landless families earning majority of their income from casual manual labour work
  • Families that are headed by women and have the absence of a male member between the ages of 16 and 59
  • Families that do not have a single adult member
  • Destitutes living in unimaginable conditions
  • People surviving on alms

Conclusion: The main aim of Ayushman Bharat is to transcend the sectoral and segmented approach of health service conveyance to a more need-based comprehensive healthcare approach. Its primary objective is to undertake ground-breaking cutting-edge initiatives in order to address healthcare at the primary, secondary, and tertiary level in a holistic manner.

Ayushman Bharat is believed to revolutionise the way healthcare is perceived in India.

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