< Daily Current Affairs & Important Editorials

---

Ayushman Arogya Mandir (existing Ayushman Bharat Health & Wellness Centres)

GS- II >>Social Justice>> Government Scheme

Context: The Union government has decided to rename the existing Ayushman Bharat Health and Wellness Centres (AB-HWCs) as ‘Ayushman Arogya Mandir’ with the tagline Arogyam Parmam Dhanam.

About Ayushman Bharat:

• The Ayushman Bharat scheme was inaugurated in alignment with the recommendations set forth by the National Health Policy of 2017.
• This visionary undertaking is meticulously designed to realise the concept of Universal Health Coverage (UHC), thus aligning with the pursuit of Sustainable Development Goals (SDGs) and the overarching commitment to ensuring inclusivity.
• The Ayushman Bharat initiative represents a conscientious endeavour to shift from a fragmented, sector-based approach to dispensing healthcare services, to a holistic and demand-responsive model of healthcare delivery.
• Ayushman Bharat seeks to revolutionise the healthcare system by introducing groundbreaking interventions that encompass prevention, promotion, and ambulatory care.
• Two interrelated components constitute the bedrock of this transformative approach: Health and Wellness Centres (HWCs) and the Pradhan Mantri Jan Arogya Yojana (PM-JAY).

Health and Wellness Centres (HWCs):

• The Indian government set in motion the establishment of an impressive network of 150,000 HWCs, a feat achieved through the transformation of pre-existing sub centres and primary health centres.
• The mandate of these centres extends to delivering Comprehensive Primary Health Care (CPHC), thereby orchestrating the convergence of maternal and child health services with the management of non-communicable diseases.
• It contemplates the provision of free essential medications and diagnostic services, thus positioning healthcare accessibility at the doorstep of communities.
• These centres are meticulously conceived to broaden the spectrum of services, assiduously catering to the diverse healthcare requisites of the population, while accentuating the principles of accessibility and equity.

Pradhan Mantri-Jan Aroya Yojana (PM-JAY):

• At the epicentre of Ayushman Bharat’s transformative design is the Pradhan Mantri Jan Arogya Yojana (PM-JAY), an initiative that transcends geographical and socioeconomic boundaries.
• This health assurance scheme pledges a health coverage of INR 5 lakhs per family per annum, earmarked for secondary and tertiary care hospitalisation.
• It is calibrated to benefit over 120 million marginalised and economically vulnerable families, encompassing nearly 550 million beneficiaries, constituting the bottom stratum of India’s population pyramid.
• The selection of eligible households is rigorously predicated on the parameters of deprivation and occupation delineated in the Socio-Economic Caste Census 2011 (SECC 2011) for rural and urban areas respectively.
• The nomenclature of PM-JAY has evolved from its erstwhile designation as the National Health Protection Scheme (NHPS), having subsumed the Rashtriya Swasthya Bima Yojana (RSBY) introduced in 2008.
• Remarkably, the PM-JAY extends its coverage to families previously included in RSBY but not presently catalogued in the SECC 2011 database.

Key features of PM-JAY:

• The scheme guarantees a comprehensive cover for secondary and tertiary care hospitalisation across an expansive spectrum of both public and private empanelled hospitals throughout India.
• Conceived with the objective of eliminating financial catastrophe arising from medical expenditure, which annually precipitates nearly 60 million individuals into the abyss of poverty, PM-JAY encompasses pre-hospitalization and post-hospitalization costs for a span of 3 days and 15 days respectively.
• Notably, the portability of benefits across the length and breadth of the nation is an inherent feature, allowing beneficiaries to seek cashless treatment at any empanelled public or private hospital.
• It includes approximately 1,929 medical procedures within the scheme, subsuming the complete spectrum of costs associated with treatment, ranging from pharmaceuticals, supplies, diagnostics, medical professional fees etc.
• The egalitarian approach to reimbursement ensures that public hospitals receive compensation equivalent to their private counterparts. It’s particularly commendable that the INR 5,00,000 coverage is attributed on a family floater basis, thereby obviating any limitations on family size or the age of members.
• In the realm of significance, the implications of PM-JAY are profound. It envisages a drastic reduction in out-of-pocket expenditures, thereby targeting the staggering statistic of 67% of health-related expenses typically borne through such means.
• Furthermore, it acts as a catalyst for fostering the growth of private sector healthcare infrastructure in second and third-tier urban centres, as evidenced by the empanelment of 23,311 hospitals, a considerable 45% of which are private establishments.
• In effect, the scheme exerts a transformative influence on the overall quality of life and population level productivity, while remaining steadfastly aligned with the noble aim of universal health coverage and the pertinent targets delineated within the Sustainable Development Goals framework.

Concerns:

• Availability of health infrastructure is low. On an average, this translates to a mere 1.28 empanelled hospitals per 100,000 population.
• The paucity of private healthcare infrastructure is a challenge, with data from ROHINI revealing a meagre 3% eligibility rate among private hospitals for the Ayushman Bharat scheme.
• Quality control presents another pertinent concern, as only 603 out of over 18,000 empanelled hospitals possess quality certification.
• Disparities in performance are manifest, with the more affluent states showcasing superior outcomes. Disparities also manifest in the distribution of facilities, particularly in the context of secondary, tertiary, and private healthcare provision.
• Furthermore, the implementation landscape is beset with challenges stemming from inadequate governance and implementation capacity in several states. The absence of standardised treatment guidelines and protocols, coupled with evidence of irrational practices driven by profit motives within hospital setups, further compounds the challenges.
• An evaluation of budgetary allocation reveals a potential shortfall, with INR 6,400 crore allocated for the fiscal year 2021, which may not be commensurate with the requirement to cater to 50 crore patients.

Way forward:

• A proactive approach to real-time data accessibility is imperative. This will facilitate continuous analysis, thereby affording the means to bridge potential gaps.
• The proposition of incorporating health into the concurrent list of responsibilities assumes significance, as the central government’s involvement in health expenditure currently amounts to a third of the total government expenditure. Such a strategic pivot will enhance central government intervention, thereby fostering marked improvements.
• A paramount objective remains the equitable distribution of resources between affluent and less prosperous states, thereby ensuring that the advantages of PM-JAY are universally attainable.
• The principles of continuous quality enhancement and accreditation, as championed by entities like the National Accreditation Board for Hospitals & Healthcare Providers (NABH), form a vital compass guiding the trajectory forward.

Source: www.thehindu.com