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Ayushman Bharat

Introduction
In 2018, the Government of India launched the ‘Ayushman Bharat’ scheme (as outlined by the National Health Policy 2017) to make healthcare services more accessible and affordable to citizens and aid the country in achieving its target of universal health coverage (UHC) by 2030.

The following are the two key components of ‘Ayushman Bharat’:

  • Establish Health and Wellness Centres (HWCs): Launched in February 2018, the scheme aimed to provide extensive healthcare services to citizens closer to their homes by establishing 1,50,000 Health and Wellness Centres (HWCs)
  • Pradhan Mantri Jan Arogya Yojana (PM-JAY): Launched in September 2018, the scheme aimed to offer secondary and tertiary care services to the vulnerable population in the society. The policy aimed to offer medical coverage of Rs. 5 lakh (US$ 6.63 thousand) per family per year for secondary and tertiary care hospitalisation to >10.74 crore poor and vulnerable families (i.e., ~50 crore beneficiaries), which constitute the bottom 40% of India’s population.

The government’s increased focus to invest in the country’s healthcare infrastructure and establish India as a global healthcare hub will further expand accessibility of healthcare services to the Indian population and strengthen the overall healthcare system. According to NITI Aayog, the Indian healthcare sector is likely to expand at a CAGR of 22% (3x) in 2016-2022 to reach US$ 372 billion in 2022, from US$ 110 billion in 2016. The government expenditure on healthcare increased by 137% YoY (Rs. 2,23,846 crore (US$ 30.70 billion)) in BE 2021-22, as against Rs. 94,452 crore (US$ 12.95 billion) in BE 2020-21. The government is planning to increase public health spending to 2.5% of the country's GDP by 2025, from 1.8% in 2020.

Through numerous health initiatives under Ayushman Bharat, the government aims to establish a ‘New India’ by 2022; thereby, increase growth & well-being, create employment and boost the healthcare sector of the country.

Need for Ayushman Bharat
The National Health Policy 2017 indicated the need to increase public healthcare spending in India due to rising demand for healthcare infrastructure & services and out-of-pocket expenditure.

The government health expenditure (GHE) per person per year was estimated at ~Rs. 1,108 (US$ 14.70), (or ~Rs. 3 (US$ 0.040) per day), according to the National Health Accounts (NHA) estimates for 2014-15. This contrasts with the out-of-pocket expenditure (OOPE) of Rs. 2,394 (US$ 31.77) for 2014-15, which accounts for 63% of the overall health expenditure.

Further, as per Health financing profile 2017 by World Health Organisation, the healthcare out-of-pocket expenditure (OOPE) in India was estimated at ~67.78% of the total health expenditure, higher than the world average of 18.2%, indicating high expenditure which leads to the high incidence of catastrophic expenditures and inequality.

To improve the public’s access to health services and meet the rising demand for healthcare infrastructure & services, the government introduced the ‘Ayushman Bharat’ scheme in September 2018. Following its launch, ~17 crore (68%) families have been estimated to be covered under PMJAY and other government-funded health schemes (e.g., Rashtriya Swasthya Bima Yojana, (RSBY), RSBY Plus, stated-owned schemes).

Ayushman Bharat: Key Initiatives and Progress
With the launch of Ayushman Bharat, India has reached a significant milestone in the pursuit for universal healthcare, as the scheme is ensuring extended services to all citizens through its twin pillars of Health & Wellness Centres (HWCs) and Pradhan Mantri Jan Arogya Yojana (PM-JAY) with bidirectional relations.

Health and Wellness Centres (HWCs)

As of April 2021, ~75,532 Ayushman Bharat Health and Wellness Centres (AB-HWCs) were operational across the country and registered a footfall of >44.24 crore, of which >23.8 crore women (53.7%) have accessed care at these centres. The government is planning to establish 1.5 lakh AB-HWCs by December 2022.

Pradhan Mantri Jan Arogya Yojana (PM-JAY)

Under the Ayushman Bharat’s Pradhan Mantri Jan Arogya Yojana (PM-JAY), ~1.59 crore hospital admissions worth Rs. 19,714 crore (US$ 2.64 billion) were registered, as of February 2021.

Progress of PM-JAY

As of February, 2021

E-cards Generated

136,172,075

Authorised Hospital Admissions (Count)

15,885,194

Authorised Hospital Admissions (Value)

Rs. 19,714 crore (US$ 2.64 billion)

 

According to Ayushman Bharat’s Pradhan Mantri Jan Arogya Yojana (PM-JAY) newsletter, 24,666 hospitals were empanelled, as of December 2020.


 

Status of implementation of Ayushman Bharat (as of September 2020)

Indicators

All India

Pradhan Mantri Jan Arogya Yojana (PM-JAY)

 

Beneficiary families covered

13.13 crore

Total hospital admissions authorised

1.24 crore (includes 5.13 lakh hospital admissions for COVID-19 testing and treatment)

Health and Wellness Centres

75,532 (as of April 2021)

Private sector partnership

  • In March 2021, the National Health Authority (NHA)—the apex government body responsible for implementing Ayushman Bharat Pradhan Mantri Jan Arogya Yojana—collaborated with UTI Infrastructure Technology and Services Limited (UTIITSL) to provide free PVC Ayushman Bharat card to PM-JAY beneficiaries in 11 states and union territories.
  • In February 2021, ~10,000 private hospitals were empanelled under Ayushman Bharat PM-JAY, >600 hospitals under the Central Government Health Scheme (CGHS) and other private hospitals, under the State Government Health Insurance Scheme, participated as COVID-19 vaccination centres in India to ramp up COVID-19 vaccination capacity.
  • In December 2020, the Asian Development Bank (ADB) approved a US$ 300 million loan to help India's urban areas strengthen and expand access to comprehensive primary healthcare and contribute to the Ayushman Bharat scheme.
  • In April 2020, the NHA announced to provide complimentary COVID-19 testing and care at private laboratories and empanelled hospitals under Ayushman Bharat schemes for beneficiaries.
  • To strengthen supply of care & treatment under the PM-JAY scheme, the NHA, in April 2020, initiated express empanelment for private hospitals to provide care for severe illnesses such as cancer and heart conditions.
  • In 2020, the NHA joined forces with SAS (a software company) to facilitate the National Anti-Fraud Unit (NAFU) to help monitor fraud and abuse occurring anywhere in the scheme's implementation structure by using data analytics.
  • In 2019, Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (PM-JAY) collaborated with players such as Ola and Uber to enable comprehensive health insurance for their driver employees and their families to help them share benefits of this scheme and ensure their health and financial security.
  • In 2019, the government partnered with Google to help speed up the digital exposure of Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (PM-JAY) by improving National Health Authority’s (NHA) digital presence and showcasing relevant content to 50 crore eligible beneficiaries.
  • In 2019, Cipla collaborated with Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (PM-JAY) to provide low-cost drugs to hospitals.

Other partnerships
The National Health Authority (NHA) collaborated with several other government, private and not-for-profit organisations to build expertise and skills to effectively implement the PM-JAY scheme.

Year

Key partnerships

Key capabilities

2019

The German Government through GiZ

The National Health Authority (NHA) partnered with the German Government through GiZ to develop capabilities in health benefit packages, support quality & policies, support state government; monitor and evaluate capacity building.

2019

The World Bank

The NHA partnered with the World Bank for capabilities in medical audits & claims adjudication, quality, capacity building, provider payment reforms & policy support, fraud management, monitor & evaluate health benefit packages, knowledge management and beneficiary empowerment.

2019

Asian Development Bank

The NHA partnered with Asian Development Bank for capabilities in capacity building, operations, policy support and research & information technology

2018

The National Skill Development Corporation

The NHA partnered with National Skill Development Corporation for skill development.

2019

The Indian Council of Medical Research

The NHA partnered with Indian Council of Medical Research for capabilities in quality, health benefit packages and research.

2019

GeM (Government e-Marketplace)

The NHA partnered with GeM for capabilities in health benefit packages and innovations in healthcare.

Source: Annual Report PM-JAY 2020

Union Budget 2021-22 Highlights

  • In the Union Budget 2021-22, the government allocated funds worth Rs. 6,400 crore (US$ 848.86 million) to the Ayushman Bharat-PM Jan Arogya Yojana (PM-JAY).
  • The government also announced that the NHA’s National Anti-Fraud Unit will implement artificial intelligence (AI) and machine learning (ML) techniques to monitor risk scoring models, social network analysis, image analytics and cluster & peer analysis.
    • According to the government, implementing and deploying AI and ML techniques will enable to effectively diagnose diseases and prevent fraud.
  • In addition, the government included TB screening in the Community Based Assessment Checklist (CBAC), as part of Ayushman Bharat’s Health & Wellness Centre programme.

The Road Ahead
As part of sustainable development goals, India is focused on achieving universal health coverage for all citizens. The government allocated Rs. 2,23,846 crore (US$ 29.69 billion) for health and well-being in the Union Budget 2021-22, up from Rs. 94,452 crore (US$ 12.53 billion) in the previous budget. India's public health expenditure as a percentage of GDP increased from 1.2% to 1.8% between FY15 and FY21 BE.

With the help of Ayushman Bharat, the government is planning to further expand its benefits to millions by offering free medicines and diagnostics at HWCs and cover most secondary and tertiary procedures under the PM-JAY. The government’s initiative such as inclusion of AYUSH Health and Wellness Centre (AYUSH HWC) as component of Ayushman Bharat in National AYUSH Mission (NAM), would enable establishment of 12,500 Health and Wellness Centres (HWCs) by the Ministry of AYUSH, under the Ayushman Bharat Scheme, in a phased manner between FY20 and FY24.

Further, amid the COVID-19-induced lockdown in 2020, the scheme was widely used by migrant workers, particularly after the implementation of portability, which allowed beneficiaries to use cashless treatment facilities in any state, with the goal of providing access to healthcare.

With the government’s continuous efforts to increase AB’s awareness and strengthen the infrastructure, the Ayushman Bharat scheme is expected to gain higher momentum in the future and yojana meet its goal of achieving universal health coverage.