Submitted by:-

Ad ib a khan
HEALTHCARE POLICY Anam sheikh
Aysha khan

& LEGISLATION Syeda fatima

Shareen khan

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CONTENTS

1. INTRODUCTION
2. HISTORY
3. COMPONENTS OF AYUSHMAN BHARAT
4. AYUSHMAN BHARAT YOJANA SCHEME
5. SALIENT FEATURES OF AB-PMJAY
6. IMPLEMENTATION
7. IMPACT HEALTH SECTOR IN INDIA
8. BENEFITS OF AYUSHMAN BHARAT YOJANA SCHEME
9. STATES/DISTRICTS COVERED
10.NATIONAL HEALTH PROTECTION SCHEME

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 INTRODUCTION

AYUSHMAN BHARAT YOJANA ~ THE PRADHAN MANTRI JAN AROGYA

YOJANA

• Ayushman Bharat or “Healthy India” is a national initiative launched by Prime

Minister Narendra Modi as the part of National Health Policy 2017, in order to
achieve the vision of Universal Health Coverage (UHC).
• It is also known as the Pradhan Mantri Jan Arogya Yojana (PMJAY) Scheme. It
is essentially a health insurance scheme to cater to the poor, lower section of
the society and the vulnerable population. The scheme offers financial
protection in case of hospitalization due to medical emergencies.
• Considered as one of the biggest healthcare schemes in the world,
• Ayushman Bharat Yojana aims to cover more than 50 crore Indian citizens.
• It is designed especially for the economically weaker sections of the country.
The PMJAY was launched in September 2018 providing health insurance
coverage of a maximum sum insured amount of Rs.5 lakh.

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 HISTORY

• In 2017 an Indian version of the global burden of disease study reported major
diseases and risk factors from 1990 to 2016 for every state in India.

• This study brought a lot of interest in government health policy because it

identified major health challenges which the government could address.

• In 2018 the Indian government described that every year, more than six crores
Indians were pushed into poverty because of out of pocket medical expenses.

• The Indian government first announced the Ayushman Bharat Yojana as

a universal health care plan in February 2018 in the 2018 Union budget of
India The Union Council of Ministers approved it in March

• In July 2018, the Ayushman Bharat Yojana recommended that people access
benefits through Aadhaar, but also said that there was a process for people to
access without that identity card
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 COMPONENTS OF AYUSHMAN BHARAT

• Ayushman Bharat adopts a continuum of care approach, comprising of two

inter- related components, which are –

• Establishment of Health and Wellness Centres

• Pradhan Mantri Jan Arogya Yojana (PM-JAY)

Health and Wellness Centers :

• The first component of this strategy was disease prevention and health
promotion to curb the increasing epidemic of non-communicable diseases.

• This was to be ensured through upgradation of the existing network of Sub-

centres and Primary Health Centres to Health and Wellness Centres (HWC).

• Nearly 150,000 HWCs are to be set up in the country over the next few years
which will work towards reducing the overall disease burden and
hospitalization needs of the population. 5
 COMPONENTS OF AYUSHMAN BHARAT

Pradhan Mantri-Jan Arogya Yojana :

• The second component was the launch of the Pradhan Mantri-Jan Arogya
Yojana (PM-JAY) which aims to create a system of demand-led health care
reforms that meet the immediate hospitalisation needs of the eligible
beneficiary family in a cashless manner thus insulating the family from
catastrophic financial shock.
• In the long run, the PM-JAY, through its system of incentives, aims to expand
the availability of its services.
• It is fully funded by the Government and provides financial protection for a
wide variety of secondary and tertiary care hospitalizations.

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 AYUSHMAN BHARAT YOJANA SCHEME

The health insurance under AB-PMJAY includes hospitalization costs of beneficiaries

and includes the below components:
• Medical examination, consultation and treatment.
• Pre-hospitalisation.
• Non-intensive and intensive care services.
• Medicine and medical consumables.
• Diagnostic and laboratory services.
• Medical implant services, wherever possible.
• Food services.
• Complication arising during treatment.
• Post-hospitalisation expenses for up to 15 days.
• COVID-19 (Coronavirus) treatment
Ayushman Bharat Yojana Scheme has some exclusions. Below components are not
covered under the scheme:
• Out-Patient Department (OPD) expenses.
• Drug rehabilitation.
• Cosmetic surgeries.
• Fertility treatments.
• Individual diagnostics.
• Organ transplant. 7
 SALIENT FEATURES OF AB-PMJAY

• Ayushman Bharat - Pradhan Mantri Jan ArogyaYojana was

launched on 23.09.2018 to provide health cover up to
Rs. 5 lakh per family per annum for secondary and tertiary
care hospitalization to around 10.74 crore poor and
vulnerable families (approx. 50 crore individuals) based on
the deprivation and occupational criteria as per the Socio-
Economic Caste Census.
• The scheme provides for paperless and cashless access to
services for the beneficiary at the point of service i.e.
empanelled public and private hospitals across India. To
facilitate this, an online transaction management system
has been adopted by States/UTs. Further, claims of the
hospitals are also settled through online portal in a time-
bound manner. 8
 SALIENT FEATURES OF AB-PMJAY-

• .
1. Government of India has launched Ayushman Bharat – Pradhan Mantri Jan
ArogyaYojana (AB-PMJAY) on 23.09.2018. PMJAY is a centrally sponsored
scheme. It is entirely funded by Government and the funding is shared between
Centre and State governments as per prevailing guidelines of Ministry of
Finance.

2. PMJAY provides health cover up to Rs. 5 lakh per family per year for secondary
and tertiary hospitalization to around 10.74 crore poor and vulnerable families
(approx. 50 crore beneficiaries).

3. PMJAY is an entitlement based scheme. This scheme covers poor and

vulnerable families based on deprivation and occupational criteria as per SECC
database.

4. PMJAY provides cashless and paperless access to services for the beneficiary
at the point of service in any (both public and private) empanelled hospitals
across India. In other words, a beneficiary from one State can avail benefits
from an empanelled Hospital anywhere in the Country. 9
 IMPLEMENTATION

.
Participation by states and union territories
India's
. 28 states and 8 union territories each make their own choice about
whether to participate in Ayushman Bharat Yojana

In February 2018 when the program was announced 20 states committed to join.

In September 2018 shortly after launch some states and territories declined to
participate in the program.

Maharashtra and Tamil Nadu initially declined to join because they each had their
own state healthcare programmes .
Those programs, Mahatma Jyotiba Phule Jan Arogya Yojana and the programme
for Tamil Nadu, were already functioning well.

These states later both joined Ayushman Bharat Yojana with special exceptions
to make it part of their existing infrastructure.
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 IMPLEMENTATION

Participation by states and union territories

..

In. a similar way, Kerala, despite having its own health program agreed to begin
using Ayushman Bharat Yogana from November 2019.

West Bengal initially joined the program but then opted out in favor of
establishing their own regional health programme.

Telangana did the same.By January 2020 Odisha had not joined the scheme In
March 2020 Delhi announced that it would join the program
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 IMPLEMENTATION

• 2.. Participation by local people

In May 2020 Prime Minister Narendra Modi said in his radio show Mann Ki
Baat that the Ayushman Bharat scheme had recently benefited more than one
crore people.
By May 2020, the scheme had provided more than 1 crore treatments with a
value of ₹13,412 crore.
The number of public and private hospitals empanelled nationwide stands at
24,432.

The Ayushman Bharat Yojana programme announced a special collaboration with

the Employees' State Insurance programme in November 2019 From June 2020,
the program had entered a pilot to cover 120,000 workers with that insurance at
15 hospitals

• A health and wellness centre established as a part of

Ayushman Bharat Yojna at Mahua community development
bloc, Bihar 12
 HOW WILL AYUSHMAN BHARAT YOJANA
IMPACT HEALTH SECTOR IN INDIA

• Healthcare services are merely available for the poor section of the country.
Ever since the PMJAY scheme introduction, it is expected to bring significant
benefits to the health insurance sector. At the same time, expanding the
presence of the health insurance market

• With the implementation of Ayushman Bharat Yojana, the health insurance

penetration will grow from 34% to 50%, according to a report by Credit Rating
Information Service of India (CRISIL).

• the scheme runs in two modes – insurance mode and trust mode. Under trust
mode, the premium is paid by the trust by pooling money from the state. In
the insurance model, the state pays the premium to the insurance company.
The insurance company is also responsible for compensating for the
expenses incurred during hospitalisation.

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HOW WILL AYUSHMAN BHARAT YOJANA
IMPACT HEALTH SECTOR IN INDIA

• With the smooth implementation of the scheme by insurers, government, and

third-party administrators, there will be a paradigm shift in the health insurance
sector. This will lead to the standardisation of regulations pertaining to the
working of the PMJAY scheme

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 BENEFITS OF AYUSHMAN
BHARAT YOJANA SCHEME

•It covers all hospitalisation expenses with cashless transactions to beneficiaries.

•Accommodation during hospitalisation.

•Pre and post-hospitalisation costs.

•Any complications arising during the treatment.

.
•Can be used by all family members.

•No cap on family size, age or gender.

•Pre-existing conditions are included from day one.

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 STATES/DISTRICTS COVERED

• Ayushman Bharat - National Health Protection Mission will be rolled out across all
States/UTs in all districts with an objective to cover all the targeted beneficiaries.
• 26 Medical speciality in 36 states / Union territories under Ayushman Bharat Yojana
S. No. Specialty HBP 2.1 S. No. Specialty HBP 2.1

Code Code

1 Burns Management BM 14 Ophthalmology SE

2 Cardiology MC 15 Oral and Maxillofacial Surgery SM

3 Cardio-thoracic & Vascular surgery SV

16 Orthopedics SB

17 Organ & Tissue Transplant OT

4 Emergency Room Packages ER
18 Otorhinolaryngology SL
5 General Medicine MG
19 Pediatric Medical management MP
6 General Surgery SG
20 Pediatric surgery SS
7 Infectious Diseases ID
21 Plastic & reconstructive Surgery SP
8 Interventional Neuroradiology IN
9 Medical Oncology MO 22 Polytrauma ST
10 Mental Disorders Packages MM 23 Radiation Oncology MR
11 Neo-natal care Packages MN 24 Surgical Oncology SC

12 Neurosurgery SN 25 Urology SU

13 Obstetrics &Gynaecology SO 26 Unspecified Surgical US

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 AYUSHMAN BHARAT
NATIONAL HEALTH PROTECTION SCHEME

Two major initiatives -2022

National health protection Scheme to

Rs. 1200 Crore allocated for 1.5
provide Hospitalisation cover to over 10
Lakh health and wellness Centres
Crore poor and vulnerable families

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 AYUSHMAN BHARAT
NATIONAL HEALTH PROTECTION SCHEME

The initiatives are as follows:-

(i) Health and Wellness Centre

• The National Health Policy, 2017 has envisioned Health and Wellness
Centres as the foundation of India’s health system
• Under this 1.5 lakh centres will bring health care system closer to the
homes of people
• These centres will provide health care; including for non-communicable
diseases and maternal and child health services
• These centres will also provide free essential drugs and diagnostic
services
• The Budget has allocated Rs.1200 crore for this flagship programme
• Contribution of private sector in adopting these centres is also expected
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 AYUSHMAN BHARAT
NATIONAL HEALTH PROTECTION SCHEME

The initiatives are as follows:-

(ii) National Health Protection Scheme

• The second flagship programme under Ayushman Bharat is National

Health Protection Scheme, which will cover over 10 crore poor and
vulnerable families (approximately 50 crore beneficiaries) providing
coverage up to 5 lakh rupees per family per year for secondary and
tertiary care hospitalization
• This will be the world’s largest government funded health care programme
• Adequate funds will be provided for smooth implementation of this
programme

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 :
THANK YOU

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