Today's Cancelled Trains
Narendra Modi
07:57
Agenda of Universal Health Coverage -Ayushman Bharat Pradhan Mantri Jan aarogya Yojana
Agenda of Universal Health Coverage -Ayushman Bharat Pradhan Mantri Jan aarogya Yojana
Ayushman Bharat –Pradhan Mantri Jan AarogyaYojana (AB-PMJAY) to be
launched by Prime Minister Shri Narendra Modi in Ranchi, Jharkahnd on September
23, 2018
India takes a giant leap towards providing
accessible and affordable healthcare to the common man with the launch of
Ayushman Bharat – Pradhan Mantri Jan AarogyaYojana (AB-PMJAY) by the Prime
Minister, Shri Narendra Modi on 23rd September, 2018 at Ranchi, Jharkhand.
Under the vision of Ayushman Bharat, Pradhan Mantri Jan AarogyaYojana
(AB-PMJAY) shall be implemented so that each and every citizen receives his due
share of health care. With Ayushman Bharat – Pradhan Mantri Jan AarogyaYojana,
the government is taking healthcare protection to a new aspirational level.
This is the “world’s largest government funded healthcare program” targeting more than 50
crore beneficiaries.
BENEFITS UNDER THE SCHEME:
Ayushman Bharat- Pradhan Mantri Jan ArogyaYojana (PMJAY) will provide a cover of up to Rs. 5 lakhs per family per year, for secondary and tertiary care hospitalization.
Ayushman Bharat- Pradhan Mantri Jan ArogyaYojana (PMJAY) will provide a cover of up to Rs. 5 lakhs per family per year, for secondary and tertiary care hospitalization.
- Over
10.74 crore vulnerable entitled families (approximately 50
crore beneficiaries) will be eligible for these
benefits.
- PMJAY
will provide cashless and paperless access to services for the
beneficiary at the point of service.
- PMJAY
will help reduce catastrophic expenditure for hospitalizations, which impoverishes
people and will help mitigate the financial risk arising out of
catastrophic health episodes.
- Entitled
families will be able to use the quality health
services they need without facing financial hardships.
- When
fully implemented, PMJAY will become the world’s largest fully
government-financed health protection scheme. It is a visionary step
towards advancing the agenda of Universal Health Coverage (UHC).
FEATURES OF THE SCHEME
Ayushman Bharat is a progression towards
promotive, preventive, curative, palliative and rehabilitative aspects of
Universal Healthcare through access of Health and Wellness Centers (HWCs)
at the primary level and provision of financial protection for accessing
curative care at the secondary and tertiary levels through engagement with both
public and private sector.
It adopts a continuum of care approach,
comprising of two inter-related components: Creation of 1,50,000
Health and Wellness Centres which will bring health care closer to the homes of the
people.
These centres will provide Comprehensive Primary
Health Care (CPHC), covering both maternal and child health services and
non-communicable diseases, including free essential drugs and diagnostic services. The first Health and
Wellness Centre was launched by the Prime Minister at Jangla, Bijapur,
Chhatisgarh on 14th April 2018.
The second component is the Pradhan Mantri Jan
ArogyaYojana (PMJAY) which provides health protection cover to poor and vulnerable
families for secondary and tertiary care.
The Health and Wellness Centres will play a
critical role in creating awareness about PMJAY, screening for non-communicable
diseases, follow-up of hospitalization cases among others. The features of the
scheme are as follows.
Pradhan Mantri Jan ArogyaYojana: Financial
protection from catastrophic expenditure:
- 71st
Round of National Sample Survey Organization (NSSO) has found 85.9% of
rural households and 82% of urban households have no access to healthcare
insurance/assurance. More than 17% of Indian population spend at least 10%
of household budgets for health services. Catastrophic healthcare related
expenditure pushes families into debt, with more than 24% households in
rural India and 18% population in urban area have met their healthcare
expenses through some sort of borrowings.
- PMJAY
primarily targets the poor, deprived rural families and identified
occupational category of urban workers’ families as per the latest
Socio-Economic Caste Census (SECC) data for both rural and urban areas as
well as the active families under the RashtriyaSwasthyaBimaYojana (RSBY).
- Approximately
10.74 crore identified families (approximately 50 crore beneficiaries)
will be entitled to get the benefits. There is no cap on family size and
age as well as restriction on pre-existing conditions.
Pradhan Mantri Jan ArogyaYojana:
Hospitalization cover from inpatient care to post hospitalisation care:
- The
objectives of the Yojana are to reduce out of pocket hospitalisation
expenses, fulfil unmet needs and improve access of identified families to
quality inpatient care and day care surgeries.
- The
Yojana will provide a coverage up to Rs. 5,00,000 per family per year, for
secondary and tertiary care hospitalization through a network of
Empanelled Health Care Providers (EHCP).
- The
EHCP network will provide cashless and paperless access to services for
the beneficiaries at the both public and private hospitals.
- The
services will include 1350 procedures covering pre and post
hospitalization, diagnostics, medicines etc.
- The
Yojana beneficiaries will be able to move across borders and access
services across the country through the provider network seamlessly.
Pradhan Mantri Jan ArogyaYojana in alliance
with the States:
- The
scheme architecture and formulation has undergone a truly federal process,
with stakeholder inputs taken from all States and UTs through the national
conclaves, sectoral working groups, intensive field exercises and piloting
of key modules.
- The
Scheme is principle based rather than rule based, allowing States enough
flexibility in terms of packages, procedures, scheme design, entitlements
as well as other guidelines while ensuring that key benefits of
portability and fraud detection are ensured at a national level.
- States
have the option to use an existing Trust/Society or set up a new
Trust/Society to implement the Scheme as State Health Agency and will be
free to choose the modalities for implementation.
- States
can implement the Scheme through an insurance company or directly through
the Trust/Society/Implementation Support Agency or a mixed approach.
PROGRESS OF THE SCHEME:
MOUs with the states: 30 states and UTs have
signed the MoU and have started working on implementation of the mission.
Maharashtra has joined on 14th August 2018. MoU has been signed with Tamil Nadu
on 11th September 2018.
Pilot launch of PMJAY:
Pilot launch of the scheme has started. The
focus of the pilot launch of the mission is to test and enhance the developed
IT systems and streamline the state preparedness for a comprehensive launch.
The pilot been done in around 22 States / UTs
(Arunachal Pradesh, Chandigarh, Chhattisgarh, Dadar Nagar & Haveli, Daman
& Diu, Haryana, Himachal Pradesh, Madhya Pradesh, Manipur, Meghalaya,
Mizoram, Nagaland, Uttarakhand, West Bengal, Uttar Pradesh, Jammu &
Kashmir, Goa, Maharashtra among others).
The pilot launch is taking place in specific
hospitals to test the Beneficiary Identification System (BIS) and Transaction
Management System (TMS) systems.
The
pilot launch involves over 1280 hospitals.
Pradhan MantriAarogyaMitra (PMAM):
- The
scheme is creating a cadre of certified frontline health service
professionals called Pradhan MantriAarogyaMitras (PMAMs) who will be
primary point of facilitation for the beneficiaries to avail treatment at
the hospital and thus, act as a support system to streamline health
service delivery.
- MoU
was signed between National Health Agency and Ministry of Skills
Development & Entrepreneurship (MSDE) on 27th August 2018 in New
Delhi.
- AarogyaMitras
training is being conducted in collaboration with National Skill
Development Corporation (NSDC) and Ministry of Skill Development to
strengthen implementation and operational preparedness.
- Training
has already been conducted in across 20 states and around 3519
AarogyaMitras have been trained so far. Training programs for State,
District and PMAMs have been conducted in 27 states.
- A
total of around 3936 personnel have been trained at state, district and
PMAM levels.
Hospital Empanelment:
So far 15,686 applications for hospital
empanelment have been received.
Fraud detection and Data privacy:
- Detailed
guidelines have been prepared to address the issues around potential fraudulent
activities that could be committed by any individual or organization.
- Anti-fraud
cells will be established at the national and state level, and strong IT
tools will be deployed to prevent and detect fraud.
- NHA
Information Security Policy & Data Privacy Policy are being
institutionalized to provide adequate guidance and set of controls on the
secure handling of Beneficiaries Personal Data & Sensitive Personal
Data in compliance with all laws and regulations applicable. International
standards/regulation, like ISO 27001, National Institute of Standards
& Technology (NIST), Health Insurance Portability and Accountability
Act (HIPAA), General Data Protection Regulation (GDPR); and Indian
regulations such as Aadhaar Act 2016, Indian IT Act 2000, IT (amendment)
Act, 2008 and Personal Data Protection Bill by former judge BN Sri
Krishnan (Yet to be enacted) are referenced while drafting these policies.
IT systems update:
- Beneficiary
Identification System (BIS) has been developed to identify and verify the
beneficiaries at CSCs and point of care.
- NHA
has tested the software in 80 districts across 10 states and further
enhanced the system based on feedback.
- Hospital
empanelment module has been active from 4th July and has already received
empanelment requests from over 7,857 hospitals across 354 districts in 22
States / UTs. A comprehensive
- Transaction
Management System (TMS) has been developed to facilitate transactions from
hospitals (such as filing pre-authorization requests and claims submission).
- There have been trainings across the state concerning the operability of IT systems to enhance the state preparedness and receive feedback on the IT systems.
- Focused
workshops have been organized to train the state level officials in
operating the developed IT systems.
- Robust
measures are being put in place in the IT platform to ensure privacy and
security of the data.
Beneficiary related:
- MoU
has been signed with Common Service Centre (CSC) for Beneficiary
Identification and will utilize the over 3 lakh village level
entrepreneurs for identifying beneficiaries.
- Personalized
Letters with unique family code are in the process of being sent to the
identified families in the Additional Data Collection Data (ADCD) drive.
This will drive awareness among the beneficiaries and further ease the
identification process when they visit points of care or CSC centres.
Ayushman Bharat – Pradhan Mantri Jan
AarogyaYojana (AB-PMJAY) is a paradigm shift from sectorial, segmented and
fragmented approach of service delivery through various national and State
schemes to a bigger, more comprehensive and better converged and need based
service delivery of secondary and tertiary care.
Source:PIBNews
Details of Speech by Prime Minister On 23.09.2018
Source:PIBNews
Details of Speech by Prime Minister On 23.09.2018
