Ayushman Bharat

1. AYUSHMAN BHARAT
BY
MRS.NAGAMANI.T
DEPT OF COMMUNITY HEALTH NURSING
QUALITY HEALTH CARE COLLEGE OF NURSING

2. INTRODUCTION-
AYUSHMAN BHARAT YOJANA/
THE PRADHAN MANTRI JAN AROGYA YOJANA
• Ayushman Bharat or “Healthy India” is a national initiative launched by Prime Minister
Narendra Modi as the part of National Health Policy 2017, in order to achieve the vision of
Universal Health Coverage (UHC).
• It is also known as the Pradhan Mantri Jan Arogya Yojana (PMJAY) Scheme. It is essentially a
health insurance scheme to cater to the poor, lower section of the society and the vulnerable
population. The scheme offers financial protection in case of hospitalization due to medical
emergencies.
• Considered as one of the biggest healthcare schemes in the world, Ayushman Bharat Yojana
aims to cover more than 50 crore Indian citizens. It is designed especially for the economically
weaker sections of the country. The PMJAY was launched in September 2018 providing health
insurance coverage of a maximum sum insured amount of Rs.5 lakh.

3. BACKGROUND
• India is the second most populous country with a total population of more than 1.3
billion people, facing inadequate supply of essential health care services.
• Despite making remarkable strides in several sectors, India is still classified as a
Lower Middle-Income Country (LMIC) according to World Bank classification of
countries based on per capita GDP, mostly due to its inconsistent socio-economic and
health indicators.
• Statistics show that more than 20 per cent of India’s population still lives under $1.9
per day
• The mission of eradication of major communicable diseases remains unfinished, the
population is also bearing the high burden of non-communicable diseases (NCDs)
and injuries. This leads to an overall rise in the demand for health care over a
prolonged period of time.

4. • The public sector hospitals in India are understandably
overburdened. Their utilization varies widely and they often have to
work under challenging circumstancing arising from the lack of
sufficient funds, a shortage of trained health workers and the erratic
and often deficient supply of drugs and equipment which adversely
impacts their functioning.
• To address these challenges, the Government of India took a two-
pronged approach under the umbrella of Ayushman Bharat.

5. COMPONENTS OF AYUSHMAN BHARAT
Ayushman Bharat adopts a continuum of care approach, comprising of two inter-
related components, which are –
• Establishment of Health and Wellness Centres
• Pradhan Mantri Jan Arogya Yojana (PM-JAY)
 Health and Wellness Centres :The first component of this strategy was disease prevention and
health promotion to curb the increasing epidemic of non-communicable diseases.
- This was to be ensured through upgradation of the existing network of Sub-centres and Primary
Health Centres to Health and Wellness Centres (HWC).
- Nearly 150,000 HWCs are to be set up in the country over the next few years which will work towards
reducing the overall disease burden and hospitalisation needs of the population.

6. Pradhan Mantri-Jan Arogya Yojana : The second component was
the launch of the Pradhan Mantri-Jan Arogya Yojana (PM-JAY)
which aims to create a system of demand-led health care reforms
that meet the immediate hospitalisation needs of the eligible
beneficiary family in a cashless manner thus insulating the family
from catastrophic financial shock.
- In the long run, the PM-JAY, through its system of incentives, aims
to expand the availability of its services.

7. - Because of its scope, PM-JAY is the world’s largest health
insurance/assurance scheme that offers a health cover to nearly
10.74 crore poor families which comes to a staggering 50 crore
Indians that form 40% of its bottom population.
- It is fully funded by the Government and provides financial
protection for a wide variety of secondary and tertiary care
hospitalizations.

8. OBJECTIVE
• The prime objective of PM-JAY is to reduce catastrophic out-of-pocket
health expenditure by improving access to quality health care for its
underprivileged population. More details on its evolution, planning,
eligibility and state wise implementation are discussed ahead.

9. BENEFITS COVERED UNDER AYUSHMAN
BHARAT YOJANA SCHEME
• The government health insurance scheme covers most of the medical
treatment costs, medicines, diagnostics and pre-hospitalisation expenses.
Additionally, the scheme offers cashless hospitalisation services through the
Ayushman Bharat Yojana/ PMJAY e-card.
• With the intention to provide accessible healthcare to the poor and needy,
the Ayushman Bharat Yojana Scheme offers coverage of up to Rs.5 lakh per
family per year for secondary and tertiary hospitalisation care.

10. The health insurance under AB-PMJAY includes hospitalization costs of beneficiaries and
includes the below components:
• Medical examination, consultation and treatment.
• Pre-hospitalisation.
• Non-intensive and intensive care services.
• Medicine and medical consumables.
• Diagnostic and laboratory services.
• Accommodation.
• Medical implant services, wherever possible.
• Food services.
• Complication arising during treatment.
• Post-hospitalisation expenses for up to 15 days.
• COVID-19 (Coronavirus) treatment.

11. Services not Covered Under Ayushman Bharat Yojana Scheme
Similar to other types of health insurance policies, the Ayushman Bharat Yojana Scheme
has some exclusions. Below components are not covered under the scheme:
• Out-Patient Department (OPD) expenses.
• Drug rehabilitation.
• Cosmetic surgeries.
• Fertility treatments.
• Individual diagnostics.
• Organ transplant.

12. FEATURES OF AYUSHMAN BHARAT YOJANA
SCHEME:
Below are some of the key features of the PMJAY scheme:
• It is one of the world’s largest health insurance schemes financed by the government of
India.
• Coverage of Rs.5 lakh per family per annum for secondary and tertiary care across public
and private hospitals.
• Approximately 50 crore beneficiaries (over 10 crore poor and vulnerable entitled families)
are eligible for the scheme.
• Cashless hospitalisation.
• Covers up to 3 days of pre-hospitalisation expenses such as medicines and diagnostics.
• Covers up to 15 days of post-hospitalisation expenses which include medicines and
diagnostics.

13. • No restriction on the family size, gender or age.
• Can avail services across the country at any of the empanelled public and private
hospitals.
• All pre-existing conditions covered from day one.
• The scheme includes 1,393 medical procedures.
• Includes costs for diagnostic services, drugs, room charges, physician’s fees,
surgeon charges, supplies, ICU and OT charges.
• Public hospitals are reimbursed at par with private hospitals.

14. LIST OF CRITICAL DISEASES OR ILLNESSES COVERED UNDER
AYUSHMAN BHARAT YOJANA SCHEME:
The medical care scheme extended coverage for more than 1300 medical packages at empanelled public and private
hospitals in the country. Below are some of the critical illnesses covered under the Ayushman Bharat Yojana:
• Prostate cancer.
• Double valve replacement.
• Coronary artery bypass graft.
• COVID-19.
• Pulmonary valve replacement.
• Skull base surgery.
• Anterior spine fixation.
• Laryngopharyngectomy with gastric pull-up
• Tissue expander for disfigurement following burns.
• Carotid angioplasty with stent.

15. AYUSHMAN BHARAT YOJANA SCHEME ELIGIBILITY CRITERIA
FOR RURAL AND URBAN POPULATION:
• The scheme has been launched to cover the bottom 40% of poor
and economically weaker sections of the country. This was based
on the deprivation and occupational criteria of the Socio-Economic
Caste Census 2011 for rural and urban areas. The Ayushman
Bharat Yojana Eligibility is designed with pre-conditions so that only
the underprivileged people of the society benefit from the initiative.

16. PMJAY RURAL:
The rural households are ranked based on their status of seven deprivation criteria. Of these, the
scheme covers all beneficiaries who fall under at least one of below six deprivation categories
and automatically includes destitute, manual scavenger families, living through alms, primitive
tribal group, bonded labourers:
• Households with only one room with Kucha walls and roof.
• No adult member in the age group between 16 and 59 years.
• No adult male member in the age group between 16 and 59 years.
• Disabled member and no-abled bodied member in the household.
• SC and ST
• Landless households and major sources of income are through manual casual labour.

17. PMJAY URBAN:
Under the scheme, urban households are categorised based on occupation. Below
are 11 occupational categories of workers who are eligible for the Ayushman Bharat
Yojana Scheme: • Beggar
• Domestic worker
• Ragpicker
• Mechanic/Electrician/Repair
Worker/Assembler
• Chowkidar/Washer-man
• Cobbler/Street
Vendor/Hawker/Other service
providers on the street.
• Plumber/Construction
Worker/Mason/Painter/Labour/
Welder/Security Guard/Coolie
• Sweeper/Mali/Sanitation
Worker
• Artisan/Handicrafts
Worker/Tailor/Home-based
Worker
• Driver/Transport
Worker/Conductor/Cart or
Rickshaw Pullers/Helper to
Drivers or Conductors
• Shop Workers/Peon in Small
Establishment/Assistant/Helpe
r/Attendant/Delivery
Assistant/Waiter

18. FINANCING OF THE SCHEME
• PM-JAY is completely funded by the Government and costs are shared between Central
and State Governments. The Government of India decides a national ceiling amount per
family that is used to determine the maximum limit of the central share of the contribution.

19. BENEFITS OF PMJAY…
Health System –
• Help India progressively achieve Universal Health Coverage (UHC) and Sustainable
Development Goals (SDG).
• Ensure improved access and affordability, of quality secondary and tertiary care
services through a combination of public hospitals and well measured strategic
purchasing of services in health care deficit areas, from private care providers,
especially the not-for profit providers.
• Significantly reduce out of pocket expenditure for hospitalization. Mitigate financial
risk arising out of catastrophic health episodes and consequent impoverishment for
poor and vulnerable families.

20. • Acting as a steward, align the growth of private sector with public health goals.
• Enhanced used to of evidence-based health care and cost control for improved health
outcomes.
• Strengthen public health care systems through infusion of insurance revenues.
• Enable creation of new health infrastructure in rural, remote and under-served areas.
• Increase health expenditure by Government as a percentage of GDP.
• Enhanced patient satisfaction.
• Improved health outcomes.
• Improvement in population-level productivity and efficiency
• Improved quality of life for the population

21. • References:
For more inofmarion
https://www.pmjay.gov.in/
https://ab-hwc.nhp.gov.in/

22. THANK YOU