Ayushman Bharat

AYUSHMAN BHARAT
SCHEME
INTRODUCTION
• “Ayushman Bharat - National Health
Protection Scheme” which will cover over
10 crore poor and vulnerable families
(approximately 50 crore beneficiaries)
providing coverage upto 5 lakh rupees per
family per year for secondary and tertiary
care hospitalization.
• Prime Minister Narendra Modi launch
programmes of Ayushman Bharat National
Health Protection Mission in Chhattisgarh
on Ambedkar Jayanti 14/5/2018)
• AB-NHPM will subsume the on-
going centrally sponsored schemes -
Rashtriya Swasthya Bima Yojana
(RSBY) and the Senior Citizen
Health Insurance Scheme
(SCHIS)”.
• Ayushman Bharat - National Health
Protection Scheme may be implement
from 15 Aug 2018 by the Prime Minister
Narendra Modi Ji.
• Mr. Manoj Jhalani , who is the
present secretary of Health & family
welfare has nominate as mission
director of this scheme.
OBJECTIVES (2018-22)
• Focus on wellness of poor families.
• Providing the medical benefits to poor
families.
• Establishing Health & wellness centers
at the nearer distance , so that patients will
not have travel a long distance.
SALIENT FEATURES
• It will have a defined benefit cover of
Rs. 5 lakh per family per year
• Benefits of the scheme are portable
across the country and a beneficiary
covered under the scheme will be allowed
to take cashless benefits from any
public/private hospitals across the country.
• The beneficiaries can avail benefits in both
public and empanelled private facilities.
• To control costs, the payments for
treatment will be done on package rate
(to be defined by the Government in
advance) basis.
• One of the core principles of Ayushman
Bharat is to co-operative federalism and
flexibility to states.
• It is proposed to set up Ayushman
Bharat National Health Protection
Mission Council (AB-NHPMC) at centre
level Chaired by Union Health and
Family Welfare Minister.
• States would need to have State Health
Agency (SHA) to implement the
scheme.
• In partnership with NITI Aayog a
robust, modular, scalable and interoperable
IT platform will be made operational
which will entail a paperless, cashless
transaction.
IMPLEMENTATION STRATEGY
• At the national level to manage, an (AB-
NHPMA) would be put in place.
• States/ UTs would be advised to
implement the scheme by a dedicated
entity called State Health Agency
(SHA)
• State can either use an existing Trust/
Society/ Not for Profit Company/ State
Nodal Agency (SNA) or set up a new
entity to implement the scheme.
• It was run by contribution of Central
Govt & state Govt (60 +40)
Major Impact
•In-patient hospitalization expenditure in India has
increased nearly 300% during last ten years (NSSO
2015)
•More than 80% of the expenditure are met by out of
pocket (OOP)
•Rural households primarily depended on their
'household income / savings' (68%) and on
'borrowings' (25%)
•The urban households relied much more on their
'income / saving' (75%) for financing expenditure on
hospitalizations, and on '(18%) borrowings (NSSO
2015)
• Out of pocket (OOP) expenditure in India is over
60% which leads to nearly 6 million families getting
into poverty due to catastrophic health expenditures
AB-NHPM will have major impact on reduction of
Out of Pocket (OOP) expenditure on ground of:
• Increased benefit cover to nearly 40% of the
population, (the poorest & the vulnerable)
•Covering almost all secondary and many tertiary
hospitalizations (except a negative list)
•Coverage of 5 lakh for each family, (no restriction
of family size)
•This will lead to increased access to quality
health and medication
•In addition, the unmet needs of the population
which remained hidden due to lack of financial
resources will be catered to
•This will lead to timely treatments,
improvements in health outcomes, patient
satisfaction, improvement in productivity and
efficiency, job creation thus leading to
improvement in quality of life
Expenditure involved
•The expenditure incurred in premium payment will
be shared between Central and State Governments
in specified ratio as per Ministry of Finance
guidelines in vogue
•The total expenditure will depend on actual market
determined premium paid in States/ UTs where AB-
NHPM will be implemented through insurance
companies
•In States/ UTs where the scheme will be
implemented in Trust/ Society mode, the central
share of funds will be provided based on actual
expenditure or premium ceiling (whichever is
lower) in the pre-determined ratio
Number of Beneficiaries
• AB-NHPM will target about 10.74 crore
poor, deprived rural families and identified
occupational category of urban workers'
families as per the latest Socio-Economic
Caste Census (SECC) data covering both
rural and urban
•The scheme is designed to be dynamic and
aspirational and it would take into account
any future changes in the exclusion/
inclusion/ deprivation/ occupational criteria
in the SECC data
States/Districts covered
AB-NHPM will be rolled out across all
States/UTs in all districts with an
objective to cover all the targeted
beneficiaries
MAJOR HEALTH INITIATIVES
1) Health & wellness centers will
be established. These centers will
provide Comprehensive health care , free
essential medicine & diagnostics
Services.
2) National Health Protection
Scheme :- It will cover 10 crore , poor
families.Under this scheme Medical
coverage of 5 lakh per family per year
will be given .

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AYUSHMAN BHARAT

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