The Shortcomings of Ayushman Bharat Yojana

  1. India is a growing nation, and as it moves towards a more wealthy nation, the burden of lifestyle diseases like diabetes and heart disease is rising, while hospitals are already overworked from treating communicable illnesses like TB and malaria.
  2. Even though the card is given to the family’s head under the program, any number of family members may sign up to get benefits. As a result, those who do not fit the requirements for Ayushman Bharat may either obtain a card for themselves using a fake poverty certificate or claim a fraudulent link to someone who already has one.
  3. The deficiencies in the fundamental infrastructure and services in HWCs have largely stayed the same, despite the inclusion of non-communicable illnesses in comprehensive care. This will put further strain on public hospitals and super-specialty clinics and push the poor to choose expensive private treatments that, after a certain point, they can’t afford.
  4. Under Ayushman Bharat, the prices specified for various treatments are moderate. As a result, services may eventually become less effective or even unprofitable for hospitals. States including Odisha, Delhi, Telangana, Kerala, and Punjab have chosen to opt out because of this.
  5. The program doesn’t cover those economically vulnerable groups that work in the organized sector and don’t have access to health insurance. These families may become impoverished as a result of significant or unforeseen medical expenses, a problem India has been combating since its independence.

Features and Analysis of Ayushman Bharat Scheme

The Government of India introduced the ‘Ayushman Bharat program in 2018 (as defined in the National Health Policy 2017) to make healthcare services more accessible and affordable to residents, and to help the country meet its aim of universal health coverage (UHC) by 2030.

Ayushman Bharat has been created to achieve the SDGs and its underlying promise to “leave no one behind.” Ayushman Bharat is an endeavor to transform from a sectoral and divided approach to healthcare delivery to a comprehensive, need-based method. It aspires to implement ground-breaking programs to address health issues comprehensively (including prevention, promotion, and ambulatory care) at the basic, intermediate, and higher levels.

The two important characteristics of ‘Ayushman Bharat‘ are as follows:

A. Establish Health and Wellness Centres (HWCs):

The initiative, which was launched in February 2018, aimed to provide quality health services to individuals closer to their homes by creating 1,50,000 Health and Wellness Centres (HWCs).

B. Pradhan Mantri Jan Arogya Yojana (PM-JAY): 

The initiative, which was launched in September 2018, aimed to provide hospital and community services to society’s most needy members. More than 10.74 crore poor and vulnerable families, or the bottom 40% of India’s population, were to receive medical coverage of Rs. 5 lakh per family per year for secondary and tertiary care hospitalization under the scheme.

PM-JAY will cover practically all secondary care and most tertiary care treatments’ medical and hospitalization costs. PM-JAY has defined 1,350 medical packages that include surgery, medical and daycare treatments, medications, diagnostics, and transportation.

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Features of the Ayushman Bharat:

It is the world’s largest medical insurance plan, funded by the Indian government. The maximum coverage amount is Rs 5 lakh. Pre-hospitalization coverage is for three days, and post-hospitalization coverage is for fifteen days, including medications and diagnostics. Hospitalization in both secondary and tertiary care is covered. Beneficiaries are provided with cashless hospitalization coverage. It starts on the first day and covers pre-existing diseases. The system has no age, family size, or gender restrictions. It includes over 1,393 treatments, including the treatment cost, accommodation costs, doctor’s fees, operating room, intensive care unit, diagnostic services, surgeon charges, and so on. In India, hospitalization coverage is available at both private and public panel hospitals....

Benefits of the Ayushman Bharat:

Ayushman Bharat Yojana (PM-JAY) offers beneficiaries coverage of up to Rs 5 lakh as well as cashless medical treatment in both public and private hospitals in India.  Every household in India that meets the Ayushman Bharat Yojana qualifying criteria can have this money covered for specific secondary and tertiary care problems. It assists families by providing access to healthcare services and financial aid for daycare treatments, including pre-existing diseases.  Across India, the plan covers over 1,350 medical packages at both public and commercial network hospitals. Accommodation while in the hospital. Everyone in the family may use it. Pre-existing conditions are covered from the start. Pre- and post-hospitalization expenses It covers all hospitalization expenditures for beneficiaries through cashless transactions. Covers any difficulties that arise during therapy. There are no limitations on age, gender, or family size....

Eligibility for Ayushman Bharat Card:

The following criteria must be met in order to be eligible for an Ayushman Card:...

The Shortcomings of Ayushman Bharat Yojana:

India is a growing nation, and as it moves towards a more wealthy nation, the burden of lifestyle diseases like diabetes and heart disease is rising, while hospitals are already overworked from treating communicable illnesses like TB and malaria. Even though the card is given to the family’s head under the program, any number of family members may sign up to get benefits. As a result, those who do not fit the requirements for Ayushman Bharat may either obtain a card for themselves using a fake poverty certificate or claim a fraudulent link to someone who already has one. The deficiencies in the fundamental infrastructure and services in HWCs have largely stayed the same, despite the inclusion of non-communicable illnesses in comprehensive care. This will put further strain on public hospitals and super-specialty clinics and push the poor to choose expensive private treatments that, after a certain point, they can’t afford. Under Ayushman Bharat, the prices specified for various treatments are moderate. As a result, services may eventually become less effective or even unprofitable for hospitals. States including Odisha, Delhi, Telangana, Kerala, and Punjab have chosen to opt out because of this. The program doesn’t cover those economically vulnerable groups that work in the organized sector and don’t have access to health insurance. These families may become impoverished as a result of significant or unforeseen medical expenses, a problem India has been combating since its independence....

Related Frequently Asked Questions and Answers:

1Q. What function does the Ayushman Card Serve?...

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