Ayushman Bharat – All you need to know about the Health Insurance

The Indian healthcare sector is growing by leaps and bounds owing to the growing demographics and the booming demand for quality healthcare. The increasing healthcare costs, rising out-of-the-pocket expenditure, inadequate public funding, and several other factors have been consistently contributing more and more to the need for health insurance. Now, India is entering a new paradigm of healthcare with a Universal Health Coverage scheme introduced recently by the Prime Minister of India.

Ayushman Bharat: What is it?

The Ayushman Bharat or Pradhan Mantri Jan Arogya Abhiyan (PMJAY) is a universal insurance scheme with a cover of INR 5 lakhs. The scheme has been touted as the world’s largest health insurance cover, benefiting over 10 crore families across the nation, particularly from the low socio-economic background. In addition to the scheme, the government has also announced to improve the healthcare infrastructure with 1.5 lakh health and wellness centers and 24 new medical colleges built to gear up for a healthcare revolution.

The PMJAY or the Ayushman Bharat is aimed at providing universal health coverage annually to more than 10.74 crore economically backward families for secondary and tertiary care hospitalization in a network of Empanelled Health Care Providers. The ambitious scheme will be providing cashless and paperless access to healthcare services for the beneficiaries at the healthcare service centers.

The scheme particularly targets the poor, deprived rural families across the country, along with several identified occupational urban workers families. The policies and schemes under the Ayushman Bharat will certainly increase the access and affordability to healthcare services among the poor and deprived families improving their quality of healthcare. Moreover, it will help reduce the overall out-of-the-pocket expenditure of impoverished people and mitigate their potential financial risks arising out of catastrophic health treatments. In a nutshell, the Ayushman Bharat scheme will create a huge impact on the health of the low-income demographic population, enhancing the quality of healthcare services and delivery for them in both urban and rural areas.

Key Features of Ayushman Bharat:

• The Ayushman Bharat scheme will be providing a cover of 5 lakhs per family per year for their secondary and tertiary healthcare facilities.
• Eligibility for the scheme is solely based on the Socio-Economic Caste Census (SECC) database, and if eligible, they get automatic coverage under this health insurance scheme.
• There is no need for any payment initially done by the recipient under the scheme, and in case of hospitalization, they are allowed to get healthcare services from any government or empanelled private hospital.
• Unlike Mediclaim or other health insurance schemes, Ayushman Bharat does not have any waiting period for pre-existing diseases/treatments. All kinds of treatments and diseases are covered right from the day of getting the Ayushman Bharat policy, which includes the benefit of both pre and post hospitalization expenses.
• Though an Aadhaar card is not mandatory to avail the scheme benefit, beneficiaries will need an ID card for receiving the free healthcare treatment from any of the hospitals.

Impact and Challenges Ahead:

Ayushman Bharat will be having a huge impact on all sectors and subsectors of the healthcare industry, however, the success of the healthcare policy lies in its implementation. With effective implementation, the scheme will get a positive impact in reducing the out-of-pocket expenses for the poor and underprivileged group of the population across the country and increasing their access to quality healthcare and medication.

According to the government statistics, the scheme will cover nearly 40 percent of the total country’s population, covering almost all secondary and many of the tertiary hospitalizations, barring a few procedures. The scheme would possibly cater to the unmet needs of the population due to lack of financial resources, leading to timely treatments, improved health outcomes, patient satisfaction, increased productivity and efficiency, thus gaining improvement in overall quality of health and life.

In order to make the scheme effective, the government will require the right infrastructure that meets the demand and needs for hospital admissions as it will increase at the rate of 6% with an average three-day hospital stay.

The Ayushman Bharat scheme has been an innovative and path-breaking episode in the history of public health in India, and when implemented in an effective and coordinated manner, it would deliver a transformative impact. Hospitals along with the whole healthcare ecosystem of insurance companies, third-party administrators and other subsectors will fall in place. Healthcare providers will witness a boom in services delivered to the vulnerable section of the society, helping them avail the best healthcare facilities at the best quality hospitals.

Overall, the government’s Ayushman Bharat scheme will have a far-reaching impact not only on the insurance landscape but on the entire Indian healthcare system, moving it closer to the goal of sustainable, universal health coverage.