The Ayushman Bharat Yojana, also called as the Pradhan Mantri Jan Arogya Yojana (PMJAY), was started off a year ago which aimed to be one of the world’s largest health insurance scheme. It was said to be the dream child of PM Narendra Modi-‘Healthcare for all’.
According to the annual report, 46.5 lakh hospital treatments were given under the scheme. Out of these, 24.7 lakh patients were treated by private hospitals in the last one year and the rest by public ones.
As many as 8,571 government hospitals and 9,665 private hospitals had been empanelled in one year.
Fraud was detected at 341 hospitals in 16 Indian states during the first year of the Ayushman Bharat scheme’s implementation, the Union government has reported . An amount of Rs 230 lakh has been recovered by the government from these hospitals.
The maximum recovery was in Uttarkahand — Rs 1.05 crore from 18 hospitals against which fraud had been detected.
Dr. Harsh Vardhan said that, government is aware of the fraud and have therefore delisted 111 hospitals to send a message. He was addressing the gathering at ‘Arogya Manthan’, celebrating a year of the Modi government’s ambitious health scheme.
He added that the names of these hospitals had been put on the website of National Health Authority (NHA) under the ‘name and shame’ policy. He also said artificial intelligence would be used to detect frauds.
PM-JAY is an umbrella health scheme under which Ayushman Bharat is implemented.
Out of 18,019 empanelled hospitals, only 603 were quality accredited or certified.
To remove this anomaly, the minister said the hospitals now being empanelled under the scheme would have to be uncredited by the National Accreditation Board for Hospitals (NABH), which certifies that hospitals are providing a certain quality of care according to the standards prescribed by it.
Among the 32 states and union territories which are part of the scheme, Rajasthan had the maximum number of hospitalisations. As many as 122 hospitalisations per lakh population took place in a year there.
It was followed by Chhattisgarh and Kerala, with 114 and 98 hospitalisations per lakh population in their respective states. Tamil Nadu, Haryana and Andhra Pradesh paid the highest per cent of claims to the insurance companies under the scheme.
Here are the primary benefits that the PMJAY scheme brings to the vulnerable sections of society as well as to the country’s healthcare landscape on the whole.
All families listed in Socio Economic Caste Census database are covered.
Priority has been given to the girl child, women and senior citizens. There is no cap on the family size and age as this health cover is meant to be inclusive for all.
It includes secondary and tertiary care:
The scheme provides those in need to get secondary healthcare benefits provided by specialists like cardiologists and urologists. Moreover, advanced medical treatment like that for cancer, cardiac surgery and other is also covered.
All pre-existing diseases covered:
Unlike most other insurance covers, the PMJAY secures those who have pre-existing illnesses, and makes treatment in all public hospitals mandatory. This means that those who require medical care cannot be turned away.
Cashless and paperless registration and administration:
Removing the burden of out-of-pocket expenses, PMJAY aims to make the entire process of paying for healthcare cashless. Additionally, PMJAY beneficiaries can avail treatment throughout India.
Substantial reduction of out-of-pocket expenditure:
All public hospitals and empaneled private hospitals have been directed to not charge any extra payment for medical care from all PMJAY beneficiaries to reduce any corruption or delay in services.
Private sector participation to help in achievement of public health goals:
Improvement of quality of life of the population:
This scheme is improving the quality of life of the weaker sections of society who are held back drastically due to health issues that can easily be tackled with timely care and finances.
PMJAY will not only lead to better infrastructure development in rural and under-served areas across the country, but also lead to more and more Indians having access to healthcare. As of now the government has created 1350 medical packages that cover day care treatment, surgery, hospitalization, cost of diagnosis and medicines with the PMJAY health cover.
By keeping the corruption and fraud under check, the Ayushman Bharat is sure bring a revolutionary change in Healthcare system of India. The whole country will have blessing of health and a wish of ‘Ayushman Bhava’ will have newer meaning.