CASE STUDY: AYUSHMAN BHARAT AROGYA

KARNATAKA

INTRODUCTION:

The World Health Organization defines universal health coverage (UHC) as a way to make it
possible for all individuals and communities to get health services that are effective and of
the promotive, preventative, curative, rehabilitative, and palliative care that they require.
Risks must be managed by reducing their likelihood or their impact because they are
unavoidable. Consequently, the idea of health insurance was created. Ayushman Bharat
Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) is India's Government-funded health
insurance scheme that covers more than 10.74 crore poor and vulnerable families. For the
benefit of a substantial portion of BPL and APL families, Karnataka has been at the forefront
of successfully implementing these health care schemes through Suvarna Arogya Suraksha
Trust on an Assurance Mode. In Karnataka, this programme is known as Ayushman Bharat
Arogya Karnataka (ABArK). Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (PM-
JAY) is the government of India's most promising investment in human capital. It shows
support for the less fortunate members of society by providing insurance against serious
illnesses. Through the engagement of the commercial sector in addition to the current
network of public hospitals, the system aims to reduce catastrophic and out-of-pocket
spending on medical care. A social tool to lessen or eliminate the risk to life and property is
insurance. The Pradhan Mantri Jan Arogya Yojana (PMJAY) has helped to address the
disparities in healthcare spending between the states, but it hasn't been able to make up for
the poorer states' innate economic disadvantages.

ABOUT AROGYA KARNATAKA SCHEME:

The United Nations' "Millennium Development Goals," which focused on improving people's
lives, came to an end in 2015. This sparked the creation of the "Sustainable Development
Goals" (SDG), which have the same overarching mission of "Ensuring healthy lives and
promoting well-being for all, at all ages." This objective specifically emphasised obtaining
Universal Health Coverage in order to guarantee everyone's wellbeing. Through the Suvarna
Arogya Suraksha Trust on an Assurance Mode, Karnataka has been at the forefront of
successfully implementing numerous health care programmes for the benefit of a significant
portion of the BPL and APL population in the State, including Road Accident Victims within
Karnataka's borders. According to a World Bank study, there has been a 64% decrease in out-
of-pocket expenses (OOE), a 64% decrease in mortality among BPL families, and a 12.3%
increase in the likelihood that households will access hospital care, all of which support the
success of implementation through the assurance mode. By combining funding from different
ongoing programmes, the government chose to expand universal health care to all Karnataka
inhabitants in the three sectors of primary, secondary, and tertiary care, thus carrying out the
SDGs' mission. Devoted to the people of Karnataka, the innovative "Arogya Karnataka" was
thus launched. With this, Karnataka is pleased to be the FIRST STATE in the nation to
announce and enact Universal Health Coverage in order to protect its citizens from poverty
and to promote their general health and well-being.

PURPOSE OF THE CASE STUDY:

Healthcare costs that are out of pocket and severely expensive are making it difficult for
Indian households to pay their bills. The loss of employment, wealth, and lives has increased
as a result of the COVID-19 epidemic. The government's decision to include covid-19
treatments in health insurance programmes like Ayushman Bharat Arogya Karnataka has
protected families from dire financial situations and unaffordable medical expenses. A covid
positive patient typically stays in the hospital for 7 to 10 days, with each stay costing about
76,644 to 12,706 rupees on average. Therefore, the purpose of the current study was to
determine how often covid-19 patients hospitalised to tertiary care hospitals used Ayushman
Bharat Arogya Karnataka.

METHODOLOGY:

It is a record-based, cross-sectional study. The study was conducted by collecting data from
the hospital medical records department by taking prior permission at Tertiary Care Hospital
of Dakshina Kannada District in Karnataka.
There were no subjects involved in the study. The study was conducted by collecting the
information from the records of all the covid-19 positive patients, who were eligible (patients
with positive test report and admitted to general ward)

Information was collected from the hospital medical records department. The data was
collected on the patients admitted for covid-19 with positive test report in the tertiary care
hospital. The covid-19 positive patient's individual information sheets were used to gather
information about socio-demographic characteristics, coverage, and utilization of ABArK.

FINDINGS:

People from various economic backgrounds have benefited from the flagship programme
during this pandemic. With this policy, the government hopes to give all low-income and
vulnerable families with high-quality healthcare, easing their financial burden and drastically
lowering their healthcare costs. The Ayushman Bharat scheme aims to give
socioeconomically disadvantaged families free access to healthcare through insurance
systems. Patients and families that need hospital care due to the pandemic struggled to get the
care they needed and to pay for it, especially in the second wave. The Ayushman Bharat
Arogya Karnataka (ABArK) scheme in the state of Karnataka was deemed to be available to
all patients admitted to the general ward with positive test results. Many families that
received high-quality healthcare because to this program's pioneering efforts saw a reduction
in their financial burden and skyrocketing healthcare costs.

When compared to a report stating that in Madhya Pradesh, only under 10% of admitted
COVID-19 patients could access benefits under the Ayushman Bharat scheme, it was
discovered that 78.8% of the covid-19 patients who were eligible subjects in the present study
(patients with positive test report and admitted to general ward) had utilised the scheme. As a
result, the private tertiary care hospital in the Dakshin Kannada District was found to have a
substantially larger percentage of the scheme's utilisation.

192 covid-19 positive patients who were admitted to the general ward in the current study
were unable to take advantage of the benefits of the ABArK scheme because they were
unable to obtain an authorization letter from the taluk/district hospital to which they
belonged, and some of them were unaware of the programme. The state and federal
governments should work together to solve these straightforward issues so that the system
can be used more effectively going forward. As the first wave of admissions slowed down in
the month of November 2020, fewer admissions were observed from January through March.
With the beginning of the second wave of COVID-19, a rise in the number of cases was
observed in the months of April and May 2021.

According to the National Health Authority's (NHA) research on PM-JAY usage trends, men
used the medication at a rate of about 55% after the lockdown, while women's use of the
medication fell to 45% afterward. In the current study, it was discovered that 62% of males
and 37.95% of women used the programme.

In the current study, it was shown that the younger population (aged 21 to 40) utilised the
programme at a slightly greater rate (33.9%) than the elderly population (aged 61 and above),
which utilised it at a rate of 30.8%. According to the National Health Authority's research,
PM-JAY under lockdown: Evidence on Utilization Trends, there has been a minor decrease
in the utilisation of PM-JAY among younger people (about 32%) and older people
(approximately 21%).  Regarding utilisation across all age groups, it is discovered that the
private tertiary care hospital has greater scheme utilisation.

CONCLUSION:

One of the best social security programmes is PM-JAY, which offers health insurance. By
organising public awareness campaigns, the implementation of this system needs to be
substantially improved. The families would benefit by having less out-of-pocket expense and
burden in accessing the healthcare facility if consumers were encouraged to use the
programme. In order to effectively reduce out-of-pocket costs, Ayushman Bharat may be
used for curative therapies as well as prevention and control measures. One of the social
security programmes offered by the Indian Central Government to patients admitted to the
general ward during the pandemic is this one.

BIBLIOGRAPHY:

Author links open overlay panelK. Shrisharath a et al. (2022) A study on the utilisation of
Ayushman Bharat Arogya Karnataka (abark) among COVID patients admitted in a
tertiary care hospital, Clinical Epidemiology and Global Health. Elsevier. Available at:
https://www.sciencedirect.com/science/article/pii/S2213398422000574 (Accessed:
February 12, 2023).
Ayushman Bharat and road to Universal Health Coverage in India (no date). Available at:
https://www.researchgate.net/publication/335883805_Ayushman_Bharat_and_road_to_
universal_health_coverage_in_India (Accessed: February 12, 2023).

About AROGYA KARNATAKA Scheme (no date) Welcome Arogya Karnataka scheme.
Available at: https://arogya.karnataka.gov.in/Forms/Aboutus.aspx (Accessed: February
12, 2023).