Fea­tures of AB-PMJAY

BioSpectrum (Asia) - - Healthcare -

A pro­gres­sion to­wards pro­mo­tive, pre­ven­tive, cu­ra­tive, pal­lia­tive and re­ha­bil­i­ta­tive as­pects of Uni­ver­sal Health­care through ac­cess of Health and Well­ness Cen­tres (HWCs) at the pri­mary level and pro­vi­sion of fi­nan­cial pro­tec­tion for ac­cess­ing cu­ra­tive care at the sec­ondary and ter­tiary lev­els through en­gage­ment with both pub­lic and pri­vate sec­tor.

Adopts a con­tin­uum of care ap­proach, com­pris­ing of two in­ter-re­lated com­po­nents: Cre­ation of 1, 50,000 Health and Well­ness Cen­tres, which will bring health care closer to the homes of the peo­ple.

HWCs will pro­vide Com­pre­hen­sive Pri­mary Health Care (CPHC), cov­er­ing both ma­ter­nal and child health ser­vices and non-com­mu­ni­ca­ble dis­eases, in­clud­ing free es­sen­tial drugs and di­ag­nos­tic ser­vices.

The sec­ond com­po­nent is the Prad­han Mantri Jan Ar­o­gyaYo­jana (PMJAY), which pro­vides health pro­tec­tion cover to poor and vul­ner­a­ble fam­i­lies for sec­ondary and ter­tiary care.

HWCs will play a crit­i­cal role in cre­at­ing aware­ness about PMJAY, screen­ing for non-com­mu­ni­ca­ble dis­eases, fol­low-up of hos­pi­tal­iza­tion cases among oth­ers.

AB-PMJAY (Fi­nan­cial pro­tec­tion from cat­a­strophic ex­pen­di­ture)

● 71st Round of Na­tional Sam­ple Sur­vey Or­ga­ni­za­tion (NSSO) has found 85.9 per cent of ru­ral house­holds and 82 per cent of ur­ban house­holds have no ac­cess to health­care in­sur­ance/as­sur­ance. More than 17 per cent of In­dian pop­u­la­tion spend at least 10 per cent of house­hold bud­gets for health ser­vices. Cat­a­strophic health­care re­lated ex­pen­di­ture pushes fam­i­lies into debt, with more than 24 per cent house­holds in ru­ral In­dia and 18 per cent pop­u­la­tion in ur­ban area have met their health­care ex­penses through some sort of bor­row­ings.

● PMJAY pri­mar­ily tar­gets the poor, de­prived ru­ral fam­i­lies and iden­ti­fied oc­cu­pa­tional cat­e­gory of ur­ban work­ers’ fam­i­lies as per the lat­est So­cio-Eco­nomic Caste Cen­sus (SECC) data for both ru­ral and ur­ban ar­eas as well as the ac­tive fam­i­lies un­der the Rash triyaSw as thy a Bi ma Yoj ana( RS BY ). Ap­prox­i­mately 10.74 crore iden­ti­fied fam­i­lies (ap­prox­i­mately 50 crore ben­e­fi­cia­ries) will be

en­ti­tled to get the ben­e­fits. There is no cap on fam­ily size and age as well as re­stric­tion on pre-ex­ist­ing con­di­tions.

AB-PMJAY (Hos­pi­tal­iza­tion cover from in­pa­tient care to post hos­pi­tal­i­sa­tion care) ● Ob­jec­tives are to re­duce out of pocket hos­pi­tal­i­sa­tion ex­penses, ful­fil un­met needs and im­prove ac­cess of iden­ti­fied fam­i­lies to qual­ity in­pa­tient care and day care surg­eries. ● Pro­vides a cov­er­age up to Rs 5 lakh (about $7000) per fam­ily per year, for sec­ondary and ter­tiary care hos­pi­tal­iza­tion through a net­work of Em­pan­elled Health Care Providers (EHCP).

● The EHCP net­work will pro­vide cash­less and paper­less ac­cess to ser­vices for the ben­e­fi­cia­ries at the both pub­lic and pri­vate hos­pi­tals.

● In­cludes 1350 pro­ce­dures cov­er­ing pre and post hos­pi­tal­iza­tion, di­ag­nos­tics, medicines etc.

Ben­e­fi­cia­ries will be able to move across bor­ders and ac­cess ser­vices across the coun­try through the provider net­work seam­lessly.

Progress of AB-PMJAY in States: 30 states and Union Ter­ri­to­ries have signed the MoU and have started work­ing on im­ple­men­ta­tion of the mis­sion.

Pi­lot launch of PMJAY:

● The fo­cus of the mis­sion is to test and en­hance the de­vel­oped IT sys­tems and stream­line the state pre­pared­ness for a com­pre­hen­sive launch ● Done in around 22 States / UTs

● Tak­ing place in spe­cific hos­pi­tals to test the Ben­e­fi­ciary Iden­ti­fi­ca­tion Sys­tem (BIS) and Trans­ac­tion Man­age­ment Sys­tem (TMS) sys­tems.

● In­volved over 1280 hos­pi­tals.

Hos­pi­tal Em­pan­el­ment: So far 15,686 ap­pli­ca­tions for hos­pi­tal em­pan­el­ment have been re­ceived.

Fraud de­tec­tion and Data pri­vacy:

● De­tailed guide­lines have been pre­pared to ad­dress the is­sues around po­ten­tial fraud­u­lent ac­tiv­i­ties that could be com­mit­ted by any in­di­vid­ual or or­ga­ni­za­tion.

● Anti-fraud cells will be es­tab­lished at the na­tional and state level, and strong IT tools will be de­ployed to pre­vent and de­tect fraud.

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