Ayushman Bharat, a government of India flagship program, was introduced as advised by the National Health Policy of 2017. The goal is to realize universal health coverage (UHC). This program was created to fulfill the Sustainable Development Goals (SDGs) and their core principle, “leave no one behind.” In an effort to transition from a sectoral and segmented strategy to the delivery of health services to a comprehensive need-based approach, Ayushman Bharat was created. With a focus on prevention, promotion, and ambulatory care at the primary, secondary, and tertiary levels of care, this program aspires to implement ground-breaking interventions. This scheme has approved by the Indian government in March 2018. It is an ambitious reform to the Indian health system that aims to provide financial health protection for 500 million of the most vulnerable Indians and stop the slide of the 50–60 million Indians who fall into poverty each year as a result of medical expenses. From April 2020 to July 2021, about 20.32 lakh Covid-19 tests and 7.08 lakh treatments were authorized under this scheme.
The goal of the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana is to lower catastrophic health costs. And to increase access to high-quality healthcare, lower unmet needs, and lower out-of-pocket healthcare costs for poor and vulnerable families in the State/Socio-Economic UT’s Caste Census (SECC) 2011 database as well as the estimated existing RSBY Beneficiary Families not included in the SECC database. To help impoverished and needy Indians, AB-PMJAY offers tertiary hospital care at an affordable price. More than 10 crore of the poorest and most vulnerable households in the nation are protected from financial danger thanks to Pradhan Mantri Jan Arogya Yojana, which also takes India one step closer to achieving universal health coverage.
Criticisms of Ayushman Bharat Yojana:
- The National Rural Health Mission (NRHM) fund has increased by barely 2%, despite the fact that the PM-JAY financial allocation has grown enormously. Thus, the plan has reduced the money available for NRHM.
- The provision of primary healthcare to the public is mostly the responsibility of the private sector under this plan. Due to the minimal control of the private sector, this has been opposed by numerous people in numerous states. To carry out such a large-scale project, there is a shortage of workers and healthcare experts. The program excludes the organised sector’s organised weaker segments, who do not have access to health insurance.
- Infrastructure is also a problem, as many primary healthcare facilities lack even the most basic amenities, such a reliable source of energy and water.
Challenges of Ayushman Bharat Yojana:
- Finance: The program’s unknowable financial cost presents the biggest obstacle. There is no actuarial database that can produce a probability distribution of the anticipated number of various health episodes requiring various treatments at various costs. Insurance companies cannot calculate the necessary premium to adequately cover the pooled risk, which is the program’s overall cost, without such a database. The actual cost of the program could leave a significant hole in the finances of the insurance companies or the federal and state governments, depending on the structure of the contract between the two parties.
- Regulation: There is a worry that the private sector is under-regulated. Therefore the government should first concentrate on making rules stronger and making sure they are upheld. Due to their significant financial clout over the private sector, purchasers of health services might enhance laws. AB-PMJAY can set pricing effectively, impact the quality of health services, encourage hospitals to improve quality using differential charges, and enforce electronic data sharing by private hospitals because it purchases health services for more than 50 crore people.
- Costly: Long-term costs for AB-PMJAY are high, as several critics have noted. Affordableness is a subjective idea. However, in order to provide the most vulnerable group with the services they desperately need, resources will be required. By 2025, the government intends to increase the budgetary allotments to 2.5% of GDP.
- Infrastructure: Starting with infrastructure that needs to be developed to be a part of a contemporary national system would be a significant barrier in implementing a national health care program. India still faces a number of basic healthcare issues, such as a shortage of doctors, an increase in infectious illness incidence, and a national budget with a relatively low level of central government spending on healthcare.
- Lack of Participation: Several private corporate hospitals have not joined the program, despite the fact that government hospitals have. Even with a government subsidy, the private hospitals claim they would not be able to provide their unique services at the government cheap cost. According to media allegations, dishonest private hospitals have misappropriated the Ayushman Bharat program by submitting phone medical bills. A strong information technology infrastructure is used in AB-PMJAY to monitor transactions and identify unusual increases across the nation. There are various difficulties, like inconsistent hospital protocols and practices for doctors.
- Cooperation of States: Since states are projected to provide 40% of the money for the program and since health is a state responsibility, it will be essential to streamline and harmonize the PMJAY with the current State health insurance programs. Telangana, Delhi, Odisha, and West Bengal have not adopted PMJAY.
Achievements of Ayushman Bharat Yojana:
- Benefits for the Poor: Within the first 200 days of its implementation, Pradhan Mantri Jan Arogya Yojana helped more than 20.8 lakh low-income and disadvantaged individuals who obtained free medical care of more than Rs. 5,000 crores.
- Covid-19: Portability, a fundamental design element of Pradhan Mantri Jan Arogya Yojana from the start of the program, serves to ensure that migratory workers who are qualified for the program can receive its services in any hospital that has been granted an impaneled status across the nation, regardless of their state of domicile.
- Over 20.8 lakh low-income and disadvantaged persons received free medical care of more than 5,000 crores rupees in the first 200 days or so of PM-JAY.
- The ability of a PM-JAY-eligible migrant worker to receive the program’s services in any hospital that has been granted an enrolled status across the nation, regardless of where they now reside, has been a major aspect of the program’s design from the beginning.
- Ayushman Bharat – Health & Wellness Centers (AB-HWCs) have received approval for more over 62,000 facilities thus far. 38,595 H&WC have been quantified out of those as reported by the States/UTs on the HWC site as of March 31, 2020.
Conclusion:
The AB-PMJAY is a remarkable opportunity to enhance the health of hundreds of millions of Indians and get rid of a significant cause of the country’s poverty. However, there are significant obstacles that must be removed in order for the Indian people to experience these benefits and for the program to sustainably advance India’s pursuit of UHC. The government’s goal is to build a “New India” by 2022 through a number of Ayushman Bharat health projects, which will promote growth and well-being, generate employment, and strengthen the nation’s healthcare system. Therefore, despite the fact that these flaws make it more difficult for planned changes to achieve their lofty goals, AB-PMJAY offers the country a chance to address ingrained problems with long-term governance, quality assurance, and stewardship. Ayushman Bharat has the potential to make a significant improvement in both the affordability of medical procedures and, consequently, the growth of the medical infrastructure. For the scheme to be successful and stay within budgetary expectations, appropriate steps must be made to manage leakages.