Center Forms Panel to Review Ayushman Bharat Scheme, Report to be Submitted in 45 Days

The panel will discuss issues, including expansion of the scheme’s beneficiary base, suggesting measures to prevent fraud, abuse or misuse.

The central government has formed a panel to assess the implementation of its flagship health insurance scheme, Ayushman Bharat. Reportedly, a 45 days deadline has been fixed to submit the findings.

Launched in September 2018, Ayushman Bharat offers secondary and tertiary care hospitalization benefits of up to INR 5 Lakh to at least 10 Cr families (50 Cr Indians), depending on their socioeconomic status.

The committee will deliberate on critical matters such as expansion of the scheme’s beneficiary base, apart from proposing measures to prevent fraud, abuse or misuse.

Constituents of the Committee

The National Health Authority (NHA), tasked with executing the PM Jan Arogya Yojana, has established an expert committee led by Dr VK Paul, a NITI Aayog member overseeing health affairs.

This committee comprises current and former officials from the Union health ministry, NHA, as well as representatives from the Insurance Regulatory and Development Authority of India (IRDAI).

Additionally, it includes group directors from prominent corporate hospitals such as Apollo and Yashoda.

Notable members of the panel include health secretary Apurva Chandra, Deepti Gaur Mukerjee, CEO, NHA; MT Krishna Babu, chief secretary, Andhra Pradesh; and IRDAI’s BC Patnaik.

Dr Indu Bhushan, the inaugural CEO of Ayushman Bharat, and Nishant Jain from the Asian Development Bank (ADB) also serve on the committee.

The Panel Focuses

The panel's primary focus revolves around ten key areas outlined by the NHA. Firstly, it aims to reassess and delineate the roles and responsibilities of both central and state entities concerning scheme policy, design, and implementation.

Furthermore, the committee will evaluate the scheme's progress across various metrics, including beneficiary identification, hospitalization rates, equitable access to healthcare services, scheme awareness.

The committee will also consider reduction in out-of-pocket expenditure related to healthcare costs, and the involvement of the private sector.

Deliberations will extend to exploring different implementation modalities such as trust, insurance, and hybrid models.

Additionally, pivotal decisions regarding the expansion of the beneficiary base and convergence strategies will be addressed.

Moreover, the panel will also focus on linkages with the Ayushman Bharat Digital Mission (ABDM) and Aayushman Aarogya Mandir (AAM) along with proposing measures to forestall instances of fraud, abuse, or misuse.

The newly formed panel is expected to explore areas or issues not explicitly addressed by the NHA, thus ensuring comprehensive oversight and strategic guidance.

Ayushman Bharat: Leading Healthcare Transformation

The Ayushman Bharat scheme seeks to enhance healthcare services and benefits through various strategies, including streamlining packages, coordinating with related health programs, and reducing out-of-pocket expenses.

Recent data indicates that over 65 million beneficiaries nationwide have availed themselves of free hospitalization benefits worth approximately INR 82,000 Cr since the inception of the Pradhan Mantri Jan Arogya Yojana (PM-JAY) in September 2018.

PMJAY offers INR 5,00,000-a-year free health cover to 107 million poor households in the country, roughly covering the bottom 40% population of the country.

Under PM-JAY, beneficiaries have access to approximately 2,000 procedures for cashless treatment, encompassing all associated costs such as treatment, medications, supplies, diagnostic services, physician and surgeon fees, as well as room, OT, and ICU charges.

The top specialty care treatments availed by beneficiaries to date are general medicine, infectious diseases, general surgery, medical oncology, ophthalmology, and orthopedics.

Among the procedures availed by the people, are haemodialysis, screening for COVID-19, multiple packages, and acute febrile illness.

The health insurance scheme launched by the central government seeks to alleviate the suffering of people due to the rising cost of healthcare.