New Delhi, Dec 13 (PTI) A government study carried out in some states observed that the Ayushman Bharat health insurance scheme since its implementation has been instrumental in increasing access to health care and in reducing out-of-pocket expenditures among beneficiaries, the Lok Sabha was told on Friday.
A baseline study was commissioned by the government in 2019-2020 to understand the impact of Ayushman Bharat — Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) across the states of Bihar, Chhattisgarh, Gujarat, Kerala, Meghalaya, Tamil Nadu and Uttar Pradesh.
The study covered a sample of 72,636 individuals, Minister of State for Health Pratap Rao Jadhav said in a written reply.
It revealed that beneficiaries were satisfied with the quality of medical services received under AB-PMJAY, Rao said.
The study also recommended strategies to increase awareness of the scheme, addressing barriers in accessing healthcare, replicating experiences from other settings like dedicated staff to guide beneficiaries, and establishing communication channels to allow people to voice their concerns.
The beneficiary base of the scheme has been continuously progressing from 10.74 crore Socio-economic caste census/Rashtriya Swasthya Bima Yojana families to 12 crore poor and vulnerable families in January 2022, the study said.
This base has been further expanded with the inclusion of 37 lakh Accredited Social Health Activist/Anganwadi Workers/Anganwadi Helpers and their families in February 2024.
Additionally, approximately 6 crore senior citizens aged 70 and above (corresponding to approximately 4.5 crore families) were brought under the ambit of the scheme in October 2024, Rao said.
Beneficiary Identification System (BIS 2.0) allows self/assisted verification and eliminates unnecessary intermediaries.
Ayushman mobile app, equipped with face-authentication technology, allows easy beneficiary verification and card creation.
Besides, the government has launched a Transaction Management System (TMS 2.0) to improve in-patient registration, pre-authorisation, admission, initial diagnosis, follow up, claims management, and payments.
It has undertaken campaigns like “Aapke Dwar Ayushman” to mobilise millions of people in seeking healthcare.
Beneficiary empowerment efforts include partnerships with grassroots workers, initiatives like Ayushman Mitra, and the issuance of Adhikar and Abhinandan Patras to inform and engage beneficiaries.
The Ayushman Bharat – Pradhan Mantri-Jan Arogya Yojana (AB-PMJAY) is completely funded by the government and the costs are shared between central and state governments.
The ratio of central share to state share in the Punjab is 60:40, Rao said. The central government’s share of grant-in-aid is for the actual cost of treatment of the beneficiary families or maximum ceiling amount decided by the government of India (presently Rs 1,052 per family per year), whichever is less.
As of now, any additional expenditure over and above the maximum ceiling amount has to be borne by the state government.
The funding of AB-PMJAY is entirely demand driven. Funds are released to the states and UTs on the basis of the actual demand received from them.
There is no allocation of funds for the states and UTs, which are required to furnish the utilisation certificate of previously received funds prior to every new fund release, Rao said.
In Punjab, the AB-PMJAY is implemented in convergence with the state’s own health assurance scheme. The total number of eligible families overall is 45 lakh.
Out of these, 16.65 lakh families are supported by both central and state governments.
The remaining families are supported under the state scheme and the treatment cost for these families is borne by the state government. PTI PLB VN VN
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