Ayushman Bharat Becomes Bigger

World’s Largest Health Insurance Scheme extends free health cover to all Senior Citizens above 70 years.

In a significant move, the Union Cabinet approved a major expansion of the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB PM-JAY) on September 11, 2024. Under this decision, all senior citizens aged 70 and above will receive health coverage, regardless of their income.

This expansion is set to benefit around 4.5 crore families, including 6 crore senior citizens, by providing them with free health insurance coverage of up to Rs 5 lakh per family. With this approval, every senior citizen in this age group will have access to the scheme’s benefits, regardless of their socio-economic status.

 Key New Developments

• New Distinct Card: Eligible senior citizens aged 70 and above will receive a new, distinct card under the AB PM-JAY scheme
• Top-Up Coverage: Senior citizens within families already covered by AB PM-JAY will receive an additional top-up cover of up to Rs 5 lakh per year. This top-up will be for them, and they will not have to share it with other family members under the age of 70.
• Family Coverage: Senior citizens who are not part of an existing AB PM-JAY family coverage will be provided with a cover of up to Rs 5 lakh per year on a family basis
• Choice of Schemes: Senior citizens who are already benefiting from other public health insurance schemes like the Central Government Health Scheme (CGHS), Ex-Servicemen Contributory Health Scheme (ECHS), or Ayushman Central Armed Police Force (CAPF) have the option to either continue with their current scheme or opt for AB PM-JAY
• Eligibility with Private Insurance: Senior citizens who are covered by private health insurance policies or the Employees’ State Insurance scheme are also eligible to benefit from AB PM-JAY

Ayushman Bharat

Launched in 2018, Ayushman Bharat is a landmark health initiative designed to provide universal health coverage, particularly for rural and vulnerable populations. The mission aims to implement transformative interventions that address health needs comprehensively across primary, secondary, and tertiary levels.

Ayushman Bharat is designed to implement transformative interventions that address the entire spectrum of healthcare across primary, secondary, and tertiary levels. It follows a continuum-of-care approach and consists of two interrelated components:

1. Ayushman Arogya Mandir

The first component of Ayushman Bharat involves establishing Ayushman Arogya Mandirs (AAM), previously known as Health and Wellness Centres (AB-HWCs).  These Ayushman Arogya Mandirs offer a broad spectrum of healthcare services, including preventive, promotive, rehabilitative, and curative care.

These centres are being created by upgrading existing Sub Health Centres (SHCs) and rural and urban Primary Health Centres (PHCs) to enhance accessibility to healthcare in both rural and urban areas. The goal is to bring healthcare services closer to communities by offering Comprehensive Primary Health Care (CPHC).

As of September 12, 2024, there are 1,74,453 Ayushman Arogya Mandir across the country. These include 1,12,617 Sub Health Centres, 23,903 Primary Health Centres, 5,123 Urban Primary Health Centres, 5,632 Urban Health and Wellness Centres and 12,178 Ayush-related Centres.

2. Ayushman Bharat Pradhan Mantri – Jan Arogya Yojana (AB PM-JAY)

The Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB PM-JAY) is the world’s largest publicly funded health assurance scheme. It provides health coverage of up to Rs. 5 lakh per family per year for secondary and tertiary care hospitalisation.

As of September 9, 2024, over 35.4 crore Ayushman cards have been issued under the AB-PMJAY across the country. The scheme is currently operational in 33 States and Union Territories (UTs) except the NCT of Delhi, West Bengal, and Odisha.

Notably, the healthcare scheme has authorized a total of 7.79 crore hospital admissions, amounting to Rs. 1,07,125 crores in financial coverage till September 9.

The AB PM-JAY scheme has been witnessing tremendous growth in its beneficiary base. Initially covering 10.74 crore poor and vulnerable families, the Government of India expanded this coverage in January 2022 to include 12 crore families, reflecting India’s 11.7% population growth since 2011.

In addition, the scheme was further extended to include 37 lakh Accredited Social Health Activists (ASHAs), Anganwadi Workers (AWWs), and Anganwadi Helpers (AWHs) and their families, providing them with free healthcare benefits. After the recent cabinet decision, AB PM-JAY is set to offer free healthcare coverage of Rs 5 lakh to all citizens aged 70 and above across the country.

 Ayushman Bharat Digital Mission

Launched by Prime Minister Narendra Modi on September 27, 2021, the Ayushman Bharat Digital Mission (ABDM) aims to establish a robust digital health ecosystem through active collaboration between public and private sectors. The Ayushman Bharat Digital Mission (ABDM), formerly known as the National Digital Health Mission, aims to support universal health coverage in an efficient, accessible, inclusive, affordable, timely, and safe manner.

ABDM is designed to create longitudinal electronic health records for citizens, enhancing healthcare accessibility, reducing care costs, and improving efficiency in health service delivery.

It facilitates continuity of care across primary, secondary, and tertiary levels seamlessly. The digital health ecosystem established by ABDM also ensures the availability of healthcare services through electronic means, particularly benefiting remote and rural areas where specialist care is often limited.

Ayushman Bharat Health Accounts (ABHA), a key part of the Ayushman Bharat Digital Mission (ABDM), is designed to support India’s integrated digital health infrastructure. It provides a 14-digit unique number that simplifies the digital access and sharing of health records. It streamlines interactions with verified healthcare providers and facilitates seamless access to lab reports, prescriptions, and other health records.

As of September 12, 2024, 66.70 crore Ayushman Bharat Health Accounts have been created with 42.01 crore Health Records linked to it.

Ayushman Bhav Campaign

The ‘Ayushman Bhav’ initiative is designed to ensure comprehensive healthcare coverage in every village and town, reflecting Prime Minister Narendra Modi’s commitment to reaching the last mile and providing access to healthcare services for all.

As of July 2024, the campaign has achieved several notable milestones:

• Wellness, Yoga, and Meditation: 16.96 lakh sessions conducted
• Teleconsultations: 1.89 crore sessions held.
• Free Drugs and Diagnostics: 11.64 crore people received free drugs, and 9.28 crore people benefited from free diagnostic services.
• Ante-Natal Check-Ups (ANC) and Immunization: Provided to 82.10 lakh mothers and 90.15 lakh children.

• Screening Services: 34.39 crore people underwent screening for TB, Hypertension, Diabetes, Oral Cancer, Breast Cancer, Cervical Cancer, and Cataract.
• Consultations and Surgeries: 2.0 crore patients received general OPD consultations, 90.69 lakh consulted specialist OPD, and 65,094 major surgeries and 1,96,156 minor surgeries were performed.
• ABHA and Ayushman Cards: 13.48 crore ABHA accounts created and 9.50 crore Ayushman cards generated.
• Ayushman Sabhas: 1.20 lakh Sabhas organized.
• Health Melas: A cumulative footfall of 20.66 crore attended 25.25 lakh health melas as of March 31, 2024.
• Ayushman – Apke Dwar 3.0: A program aimed at bringing healthcare services directly to the doorstep.
• Ayushman Sabhas: Community gatherings to raise awareness and facilitate access to health services.
• Ayushman Melas: Health and Wellness fairs, along with medical camps organized by medical colleges at Community Health Centres (CHCs), to provide extensive healthcare services.

Conclusion

Ayushman Bharat represents a groundbreaking shift in India’s healthcare landscape by seamlessly integrating comprehensive care across primary, secondary, and tertiary levels. Through its umbrella features, the scheme not only addresses immediate health needs but also emphasizes preventive care and health promotion, making healthcare more accessible and equitable.

As Ayushman Bharat continues to evolve, it is set to further transform India’s health sector by expanding access to quality healthcare services, reducing the financial burden on families, and improving overall health outcomes. This comprehensive approach will likely lead to a more inclusive and efficient healthcare system, setting a precedent for health reforms and driving long-term improvements in public health across the country.