Fall in Treatment Under Ayushman Bharat Yojana | 07 May 2020

Why in News

According to recent data provided by the National Health Authority (NHA), the number of treatments for non-Covid procedures by both private and government facilities across the country dropped by over 20% between February, 2020 and April, 2020.

Key Points

  • The Covid-19 pandemic and the lockdown have adversely affected the Ayushman Bharat-Pradhan Mantri Jan Arogya Yojana’s (AB-PMJAY) ability to cater to critical patients below the poverty line.
    • Cardiology treatments offered under AB-PMJAY declined by 45%.
    • General Surgeries’ declined by 23%.
    • Procedures related to gynaecology and obstetrics declined by 25%.
  • The only category of treatment that showed an increase was ‘General Medicine’.
  • The treatments available under AB-PMJAY can be accessed at several private care hospitals. However, because of lockdown, private hospitals across the country are largely shut down.
  • The government itself is encouraging people with ‘non-critical’ illness to access hospitals via telemedicine or only partake of essential treatments (dialysis or non-elective surgeries) at hospitals.
  • Moreover, with several reports of Covid-19 infections in healthcare workers and doctors across private and public hospitals, the number of visits to hospitals in general saw a decline.

Ayushman Bharat Pradhan Mantri Jan Arogya Yojana

  • PM-JAY offers a sum insured of Rs.5 lakh per family for secondary care (which doesn’t involve a super specialist) as well as tertiary care (which involves a super specialist).
  • It is an entitlement-based scheme that targets the beneficiaries as identified by latest Socio-Economic Caste Census (SECC) data.
    • Once identified by the database, the beneficiary is considered insured and can walk into any empanelled hospital.
  • The insurance cost is shared by the centre and the state mostly in the ratio of 60:40.
  • Packaged rates (Rates that include everything so that each product or service is not charged for separately):
    • They also mention the number of average days of hospitalization for a medical procedure and supporting documents that are needed.
    • They are flexible, but they can’t charge the beneficiary once fixed by the hospitals.
    • The scheme also has prescribed a daily limit for medical management.
  • The National Health Authority (NHA) has been constituted as an autonomous entity under the Society Registration Act, 1860 for effective implementation of PM-JAY in alliance with state governments.
  • The State Health Agency (SHA) is the apex body of the State Government responsible for the implementation of AB PM-JAY in the State.

Source: TH