Ayushman Bharat or PM Jan Arogya Yojna is set to be rolled out across the nation on September 23, 2018. It is meant for those who cannot afford their own medical care and holds special significance for Bharat or rural India. It has an open-ended commitment from the finance ministry and as such, there is no fixed budget.
All states except 2 hold-outs will soon join. South India which has good health coverage, also sees merit in this scheme. Two features are worth mentioning. Firstly states have some flexibility to pay more for private or higher grades of hospitals. The other is portability, which extends care from any govt or empanelled hospital in the country. Thus, while capacity is being built in rural North & East India, patients will prefer to go to major cities or other states. It is an opportunity for States to facilitate and for hospitals to improve quality, specialise and expand.
Ayushman Bharat is not comprehensive in all respects. For example, it doesn't offer long-term care in nursing homes. This is where well-meaning states can do more. Some states are far ahead in facilities and services ensuring "healthcare for all". For example, Andra Pradesh offers accessible, cost-effective & quality health care for all segments of society, from ‘Arogya Raksha’ to ‘Chandranna Sanchara Chikitsa’ or the ‘Feeder Ambulances (108 Bike). They should serve as role models for other states.
Push for nation-wide adoption & roll out by states
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Most states had entered into MOU with Centre. Haryana & UP had already started pilot runs, but many states (eg. Maharashtra, Rajasthan, Bihar and Sikkim) had to be nudged to do more for a successful rollout.
▒■ National Health Agency (NHA) @AyushmanNHA
Aug 28
Pilots of #AyushmanBharat has started in 16 States / UTs and others will also start pilots before fully launching the scheme on 25th September.
▒■ Skill India @MSDESkillIndia
Aug 27
Skill India will train 1 lakh Arogya Mitras who will have the right skills & knowledge to handhold beneficiaries, to enrol & assist them in verification & maintain transparency.
▒■ National Health Agency (NHA) @AyushmanNHA
Aug 28
NHA is in talks with 5 top global data analytical companies for proof of concept for fraud prevention, detection and deterrence.
▒■ ANIL VIJ MINISTER HARYANA @anilvijminister
Sep 1
We are the 1st to launch #AyushmanBharat scheme in all the districts of Haryana.
Haryana launched the scheme a month early, on Independence Day. On 7th Sept, Jammu & Kashmir launched as well. Still, 7 states had not signed an MOU and all were ruled by opposition parties. Even they soften their stance, as Tamil Nadu signed on 11th Sept, Karnataka should join 2 days later, and Punjab and Telangana will follow suit. Kerala says it is pre-occupied with flood disaster (though it wants to join), whilst Delhi & Odisha are staying away. In fact, Odisha not only refused to join but is launching its own parallel health insurance scheme!!
All states except 2 hold-outs will soon join. South India which has good health coverage, also sees merit in this scheme. Two features are worth mentioning. Firstly states have some flexibility to pay more for private or higher grades of hospitals. The other is portability, which extends care from any govt or empanelled hospital in the country. Thus, while capacity is being built in rural North & East India, patients will prefer to go to major cities or other states. It is an opportunity for States to facilitate and for hospitals to improve quality, specialise and expand.
Ayushman Bharat is not comprehensive in all respects. For example, it doesn't offer long-term care in nursing homes. This is where well-meaning states can do more. Some states are far ahead in facilities and services ensuring "healthcare for all". For example, Andra Pradesh offers accessible, cost-effective & quality health care for all segments of society, from ‘Arogya Raksha’ to ‘Chandranna Sanchara Chikitsa’ or the ‘Feeder Ambulances (108 Bike). They should serve as role models for other states.
Push for nation-wide adoption & roll out by states
Most states had entered into MOU with Centre. Haryana & UP had already started pilot runs, but many states (eg. Maharashtra, Rajasthan, Bihar and Sikkim) had to be nudged to do more for a successful rollout.
▒■ National Health Agency (NHA) @AyushmanNHA
Aug 28
Pilots of #AyushmanBharat has started in 16 States / UTs and others will also start pilots before fully launching the scheme on 25th September.
▒■ Skill India @MSDESkillIndia
Aug 27
Skill India will train 1 lakh Arogya Mitras who will have the right skills & knowledge to handhold beneficiaries, to enrol & assist them in verification & maintain transparency.
▒■ National Health Agency (NHA) @AyushmanNHA
Aug 28
NHA is in talks with 5 top global data analytical companies for proof of concept for fraud prevention, detection and deterrence.
▒■ ANIL VIJ MINISTER HARYANA @anilvijminister
Sep 1
We are the 1st to launch #AyushmanBharat scheme in all the districts of Haryana.
Haryana launched the scheme a month early, on Independence Day. On 7th Sept, Jammu & Kashmir launched as well. Still, 7 states had not signed an MOU and all were ruled by opposition parties. Even they soften their stance, as Tamil Nadu signed on 11th Sept, Karnataka should join 2 days later, and Punjab and Telangana will follow suit. Kerala says it is pre-occupied with flood disaster (though it wants to join), whilst Delhi & Odisha are staying away. In fact, Odisha not only refused to join but is launching its own parallel health insurance scheme!!
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- Interview: JP Nadda, Union Health Minister
Our journey to bring the Ayushman Bharat---------------------------------------
From the announcement of the scheme in the Union budget on 1st Feb, we got the health programme approved in quick time on 20th Mar. Consultations had taken place with states on broad parameters they wanted and with DGHS (director general of health service) on procedures that would be offered for free. Then we formed the National Health Agency (NHA) and asked states to form state health agencies. By June, when 19 states were on board we were working together to prepare for implementation. We offered three financing models — insurance model, trust model and the hybrid model— and after examining them, most states chose the trust model.
1) Ayushman Bharat will be a paperless & cashless system so we brought the best IT support on board.
To stop frauds, there are 94 types of automatic checks in the digital system that will set off alarms. There will be social audits, and we will improve the system as we progress. Data security of international standards has been maintained. It is the first time such data security systems (SOP) are being used in India for protecting data.
2) Arogya Mistra will interface btw patients and hospitals (public and private). National Skill Development Corp will train 100,000 AM, incl 10,000 for private hospitals.
3) Beneficiaries will be sent letters with individualised QR codes. This letter is taken to an Arogya Mitra at the hospital, where all family members can be registered. Local health workers among others will do the distribution of letters. Common service centres — around 300,000 in villages — can also verify names of the individual on the list. A website is available for the same.
4) Hospital doctors can prescribe 1,350 procedures. After admission & treatment, a feedback is taken and monies paid within 15 days of the discharge date. In an emergency, it is assumed there is approval. It is deemed approved if a denial is not received in 1/2 hour. Complaints can be made online and offline to the state health agency and within 15 days, they need to submit the report.
5) AB is taking applications from district hospitals and above, that have the capacity for life-saving procedures. We have around 10,000 private hospitals empaneled, which is not enough. We have allowed states to pay a little more for some hospitals. For example, TN has a scheme where higher grade hospitals have higher packages. Also, we have an MOU with IMA (Indian Medical Association), so we expect more hospitals to join.
6) Inevitably there will be demand-supply gaps in health infrastructure and human resources. We have focused on 8 such weak (or EAG) states. More hospitals are getting built in Tier 2 & 3 cities and towns. In the meanwhile, doctors from larger hospitals will visit other district hospitals on different days. If surgeries are not open, people will go to other places. I strongly believe capacities will expand fast because hospitals will be earning extra monies.
7) In this pre-launch period, we are holding pilot rollouts. PM Modi is taking weekly reviews on beneficiaries list, training and IT. We want the IT system should be able to handle demand on a massive scale. Beneficiaries lists have not been fully finalised as extra care is being taken to get the correct spelling of names. QR must also capture all the family members.
8) AB has an open-ended commitment from finance ministry so there is no need for a fixed budget. It also means that public budget allocation for health will automatically rise as health coverage expands.
9) AB is a holistic scheme which has a primary health and screening component available to all, and to be done in health and wellness centres. We projected requirement for 150,000 centres, but we are starting slowly by adding just 10,000 in first year & 40,000 in next year. This will give us time to train staff and trainers before scaling up.
10) AB offers universal health screening of cervix cancer, breast cancer, oral cancer, hypertension, diabetes, tuberculosis and diabetes. Centre will continue to assist everyone in select conditions such as renal dialysis. Then we have free drugs and diagnostic facilities for all. Under free drugs, 50 types of drugs will be available at PHCs, more than 100 drugs at CHCs, and more than 600 drugs at district hospitals. All drugs will be digitally managed. IT-enabled systems will monitor medicines stocks in all health centres.
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