Ayushman Bharat Yojana

Why in the news?

• According to data presented in Parliament by the Union Ministry of Health and Family Welfare, beneficiaries aged 70 years and above account for more than 12 percent of the total enrolments under the Ayushman Bharat Health Insurance Scheme

UPSC Syllabus: Prelims: Social Development Mains: GS-II, GS-III: Government Policies and Interventions, Social Development, Health

What is the Ayushman Bharat Yojana?

• Ayushman Bharat, a flagship scheme of the Government of India, was launched in 2018 as the National Health Policy 2017 recommended.
• Launched: Inaugurated by Prime Minister Narendra Modi on 23 September 2018.
• Objective: To achieve the vision of universal health coverage (UHC). 

Commitment to Sustainable Development Goals

• This initiative is designed to meet Sustainable Development Goal (SDG) number 3, which aims to ensure healthy lives and promote well-being for people of all ages, and its underlying commitment, which is to “leave no one behind”.

Components of Ayushman Bharat Yojana

•  Ayushman Bharat adopts a continuum-of-care approach, consisting of two interrelated components:

1. Pradhan Mantri Jan Arogya Yojana (PM-JAY)

• Pradhan Mantri Jan Arogya Yojana (PM-JAY) provides health insurance coverage of Rs 5 lakh annually to over 10 crore poor and vulnerable families seeking secondary and tertiary care.

Key Features of PM-JAY

• Coverage: It provides health insurance coverage of Rs 5 lakh per family year.
• Beneficiaries: Over 10 crore poor and vulnerable families (about 50 crore individuals).
• Cashless and Paperless Access: The scheme provides cashless and paperless access to healthcare services at the point of service.
• Impaneled Hospitals: PM-JAY allows beneficiaries to avail of services from impaneled public and private hospitals across the country.

2. Health and Wellness Centres (HWC)

• Health and Wellness Centres (HWC) are set up to provide comprehensive primary healthcare services.

Key Features of HWC

• Scope of Services: It includes maternal and child health services, non-communicable diseases, mental health services, and free essential drugs and diagnostic services.
• Coverage Extent: Aims to cover the entire population with quality health services.
• Preventive and Promotive Health: Focus on preventive and promotive health care through wellness activities and community engagement.

Universal Health Coverage (UHC)

• Universal health coverage (UHC) is a healthcare system in which all individuals and communities receive the healthcare services they need without facing financial hardship.
• ⦁ UHC is based on the principles of equity, quality, and financial protection.

Key Aspects of UHC:

• Equity in Access: It ensures that everyone, regardless of their socio-economic status, has access to quality healthcare services.
• Quality of Health Services: Health services must be of good quality to improve the health of those receiving care.
• Financial protection: It ensures that the cost of accessing healthcare services does not put people at risk of financial hardship.

UHC in India:

• India’s commitment to UHC is reflected in the Ayushman Bharat scheme, which aims to provide affordable, accessible and equitable healthcare to the population, especially the economically weaker sections of society.

Progress and achievements under the Ayushman Bharat scheme

•  The scheme was extended to ASHA and Anganwadi workers in the interim budget, but the July budget made no mention of further expansion, with the allocation marginally increased to Rs 7,300 crore.

Hospitalisation and expenditure

Senior citizens’ admission:

• Data shows that of the nearly 6.2 crore approved hospitalizations till January 2024, 57.5 lakh were senior citizens aged 70 years and above.

Government expenditure: 

• Government expenditure for treatment under the scheme reached Rs 79,200 crore in the last six years till January 2024, of which Rs 9,878.5 crore was allocated for treatment of people aged 70 years and above.

Impact on older population

• Expanding coverage:  With an older population having inadequate health coverage, expanding the scheme to people above 70 years of age across all income groups is expected to have a significant impact.
• Population projections: According to the Longitudinal Ageing Study in India (LASI), India’s population above 60 years of age is projected to increase from 8.6 percent in 2011 to 19.5 percent by 2050. 
  • This means that the population above 60 years of age will increase from 103 million in 2011 to 319 million in 2050. 

Milestones achieved

•  30 Crore Ayushman Cards: By January 2024, the Ayushman Bharat Yojana has crossed the milestone of issuing 30 Crore Ayushman cards.
• These cards are mandatory for beneficiaries to avail of healthcare services under the scheme.

Ayushman App:

• To facilitate the generation of Ayushman cards and last-mile access, the National Health Authority (NHA) launched the ‘Ayushman App’.
• The app aims to streamline the process and make it more accessible to the general public.

State-wise distribution of Ayushman cards

• Uttar Pradesh: Uttar Pradesh leads the list with the issuance of 4.83 crore Ayushman cards, making it the state with the highest number of cards.
• Madhya Pradesh: Madhya Pradesh is in second place with 3.78 crore Ayushman cards.
• Maharashtra: Maharashtra is in third place with the issuance of 2.39 crore Ayushman cards.

Gender Equality in Healthcare

Women Beneficiaries:

• One of the notable achievements of the Ayushman Bharat scheme is its focus on gender equality.
• Around 48% of the treatments provided under the scheme have been received by women beneficiaries.
•  This highlights the scheme’s inclusive approach towards healthcare.

Challenges associated with public health systems in India

Key Challenges

• Inadequate Infrastructure: Many healthcare facilities in India, especially in rural areas, lack adequate infrastructure. 
•  This includes inadequate hospital beds, outdated equipment, and a lack of medical supplies.
  •  Example: Many primary health centers (PHCs) in rural areas of states such as Bihar and Uttar Pradesh lack basic infrastructure such as proper buildings, adequate medical supplies, and working equipment. 
• This severely limits their ability to provide quality care to patients.

Shortage of Healthcare Professionals: 

• India has a severe shortage of doctors, nurses, and other healthcare professionals. The doctor-patient ratio is below the level recommended by the WHO.
  • Example: According to the Indian Journal of Public Health, India has a shortage of over 600,000 doctors and 2 million nurses. 
  • There is a shortage of qualified healthcare professionals, especially in rural areas, leading to reliance on unqualified practitioners. 

Unequal access to healthcare:

•  Inequalities in access to healthcare exist between urban and rural areas, as well as between different socio-economic groups.
  • Example: In states such as Jharkhand and Chhattisgarh, there are significant inequalities in access to healthcare between urban and rural areas.
  • Urban areas have many hospitals and specialized services, while rural areas often have only basic health centers with limited services.

Poor health financing:

• Public expenditure on health is low, leading to high out-of-pocket expenditure by individuals. This often leads to financial hardship for families.
  • Example: In India, out-of-pocket expenditure accounts for about 62% of total health expenditure. 
  • Many families are pushed into poverty due to high medical costs, as seen during the COVID-19 pandemic, where families have to bear excessive costs for hospital treatment.

Administrative and governance issues: 

•  Fragmented governance and lack of coordination between the central and state governments lead to inefficiencies in the delivery of healthcare services. 
  • Example: The implementation of health schemes such as Ayushman Bharat often faces delays and inefficiencies due to poor coordination between the central and state governments. 
  • For example, in some states, the empanelment of hospitals under the scheme has been slow, affecting patients’ access to services. 

Measures to improve the Indian public healthcare system 

Strengthening healthcare infrastructure:

• Investing in the development of health infrastructure, including building new hospitals, upgrading existing facilities, and ensuring the availability of modern medical equipment. 
  • Example: The government can invest in upgrading PHCs and community health centers (CHCs) with better facilities and equipment. 
  • The state of Kerala has implemented the Ardram Mission to transform primary health centers into family health centers with better infrastructure and services.

 Increasing the healthcare workforce:

• Expanding medical education and training programs to produce more doctors, nurses, and allied health professionals.
• Implementing incentives to retain healthcare workers in rural and deprived areas.
  • Example: The National Health Policy 2017 proposes to increase the number of medical colleges and nursing schools, especially in deprived areas. 
  • The establishment of All India Institutes of Medical Sciences (AIIMS) in various states is a step in this direction.

Ensuring equitable access to healthcare:

•  Increasing access to healthcare services in rural and remote areas through mobile clinics, telemedicine, and community health worker programs.
  • Example: Initiatives such as the National Rural Health Mission (NRHM) aim to increase healthcare delivery in rural areas through mobile medical units, telemedicine services, and the recruitment of community health workers known as accredited social health activists (ASHAs).

Increasing health financing:

•  Increasing public expenditure on health to reduce out-of-pocket expenditure and provide financial security to the population.
• Implementing health insurance schemes like Ayushman Bharat to cover a larger section of the population.
  • Example: Increasing the health budget to at least 2.5% of GDP as recommended by the National Health Policy can help reduce out-of-pocket expenditure.

Improving governance and accountability:

• Strengthening health sector governance through better coordination between the central and state governments.
•  Implementing strong monitoring and evaluation systems to ensure accountability and transparency in healthcare delivery.
  •  Example: Strengthening the National Health Mission (NHM) to ensure better coordination between various health programs and enhance the accountability of state health departments through regular audits and performance reviews.

Promoting preventive healthcare:

• Focusing on preventive healthcare measures such as immunization, health education, and early detection of diseases to reduce the overall burden on the healthcare system.
  •  Example: Expanding immunization programs, promoting hygiene and cleanliness through Swachh Bharat Abhiyan, and implementing school health programs to educate children about healthy behaviors can reduce the disease burden to a great extent.

स्रोत – इंडियन एक्सप्रेस