Healthcare in India is often touted to be abysmal, not only in terms of facilities given to people, but also because the number of people in abject poverty who cannot afford to avail quality medical treatment for their illnesses.
A lack of comprehensive social insurance also means that people must pay these expenses out of pocket
Under Ayushman Bharat, the eligible families are covered up to Rs. 5 lakh annually. The eligibility depends on the Socio-Economic Caste Census of the year 2011. The families identified in the census are only allowed to take benefits under the scheme. It aims to cover 10 crore families in urban and rural areas.
The coverage provided works as a family floater. It covers secondary and tertiary hospitalisation expenses through a cashless scheme. It also covers pre and post hospitalisation costs. Day care procedures are inclusive. The Health Ministry has notified 1,345 packages whose costs are 15-20 per cent cheaper than under the Central Government Health Scheme. These include procedures such as coronary bypass, knee replacement, coronary stents, caesarean section, hysterectomy, etc.
The scheme works as an insurance policy for the underprivileged. They need not spend for treatment. The scheme is cashless with payment directly made to the hospital. The settlement of the procedure costs depends on the package rates notified by the Government. For instance, if a caesarean procedure costs Rs. 6,000 under the package, that amount gets paid to the hospital.
How is the scheme administered?
The list of beneficiaries has been picked from Socio-Economic Caste Census and the State Governments along with the districts has been working to identify such families and verifies their information. It is also works on educating these people about the scheme. However, the State Government can choose whether to be a part of the scheme or not. In addition to this, each hospital is supposed to have an Ayushman Mitra, who will be available to solve any queries about the scheme. The Ayushman Mitra also checks eligibility and verify documents of the families admitted.
Who will bear the treatment costs?
The Ayushman Bharat scheme is a Government sponsored health scheme. It operates by providing health insurance to the eligible families. The premium for the scheme is to be shared by the central and state governments in the ratio of 60:40. In case of the North East states, Jammu & Kashmir, Himachal Pradesh and Uttarakhand, this ratio is 90:10. In case of Union Territories without legislature, 100 per cent of the funding will be borne by the Central Government.
The scheme can be administered as a trust model (where the Government will reimburse the hospitals directly) or an insurance model (in this case, the Government will pay premium to an Insurance Company who will then settle the bills with the hospital directly). Most states have opted for the trust model while some have opted for a mixed implementation. States can also run the scheme along with their health schemes. For example, Odisha has its beneficiary health scheme which it runs along with Ayushman Bharat scheme.
The scheme has helped people avail cheaper medical treatment without causing a dent in their finances. Hospitals and wellness centres have been added in the country to help improve the healthcare. The scheme hopes to improve the on-ground condition of the healthcare.
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