Ayushman Bharat Yojana Efficiency Evaluation PDF

Assignment Title Evaluation of the Efficiency of Ayushman Bharat Yojana Course Name : Public Economics : Theory and Practice Submission Date : 17th September 2024 Name : Sara Shaikh Shamsuddin Rollno. 2324-ART34-284 INTRODUCTION In 2017, the Indian government launched the National Healt...

Assignment Title Evaluation of the Efficiency of Ayushman Bharat Yojana Course Name : Public Economics : Theory and Practice Submission Date : 17th September 2024 Name : Sara Shaikh Shamsuddin Rollno. 2324-ART34-284 INTRODUCTION In 2017, the Indian government launched the National Health Policy, with the ambitious objective of achieving Universal Health Coverage [UHC] through the National Health Authority. It consists of two interconnected components: Health and Wellness Centres [HWCs] for basic health care and Pradhan Mantri Jan Arogya Yojana [PM-JAY] for higher tertiary care. In 2018, the government of India launched the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana [AB PM-JAY]. The goal is to relieve the burden of health-care costs on lower-income people. As a result, numerous health benefit packages were established to address prevalent health issues.. The Ayushman Bharat Yojana Is the world’s largest health-insurance setup. The government covers the entire cost. It is intended to assist more than 500 million individuals in India by giving up to Rs. 5 lakh in yearly insurance coverage for families. KEY OBJECTIVES OF AYUSHMAN BHARAT YOJANA 1- UNIVERSAL HEALTH COVERAGE The primary goal of Ayushman Bharat is to provide universal health coverage to all citizens, with a particular emphasis on the economically disadvantaged. It aims to cover around 50 crore people, providing access to necessary medical treatments without imposing financial burdens. 2- FINANCIAL PROTECTION The policy offers health Insurance coverage of Rs 5 lakh per family per year for secondary and tertiary care hospitalization. This financial protection aims to reduce the out-of-pocket expenses that families incur during medical emergencies, thus preventing them from depleting their savings or selling assets for healthcare. 3- CASHLESS TREATMENT Beneficiaries can receive cashless treatment at affiliated public and private hospitals throughout India. This feature significantly reduces the financial strain during critical medical situations, allowing families to focus on healing rather than financial concerns. 4- EXTENSIVE MEDICAL CARE Ayushman Bharat covers more than 1,500 medical packages, including hospitalization, surgery, diagnostics, and pre- and post-hospitalization expenses. This comprehensive coverage ensures that beneficiaries have access to a broad range of quality healthcare services. 5- STRENGHTENING PRIMARY HEALTHCARE The initiative calls for the creation of 1,50,000 Health and Wellness Centers (HWCs) across the country. These centers are intended to deliver comprehensive primary healthcare services, with a focus on disease prevention and chronic illness management 6- EMPOWERING WOMENS HEALTH Women’s health issues are addressed specifically, including maternity care and cervical and breast cancer screenings. This focus emphasizes gender equality in healthcare access.  7- REDUCING HEALTH DISPARITIES The scheme aims to close the healthcare access gap between urban and rural populations by expanding coverage to underserved communities. This effort aims to promote equitable healthcare services, regardless of socioeconomic status or geographical location. 8- EMPLOYMENT GENERATION IN HEALTHCARE SECTOR Ayushman Bharat has increased the demand for healthcare services through this initiative, contributing to job creation in the healthcare sector, enhancing workforce capacity, and improving overall economic growth. 9- TECHNOLOGY DRIVEN BENEFICIARY IDENTIFICATION The scheme uses technology to identify and enroll beneficiaries through Aadhaar cards. This system improves efficiency and ensures that eligible individuals can easily register and receive benefits. 10- COMPREHENSIVE APPROACH TO HEALTHCARE Ayushman Bharat takes a comprehensive approach to health service delivery, integrating preventive, promotional, curative, palliative, and rehabilitative care at the primary, secondary, and tertiary levels. To summarize, the Ayushman Bharat Yojana seems a significant breakthrough towards increasing healthcare accessibility and affordability in India by addressing financial barriers and improving overall healthcare infrastructure for vulnerable populations. But it’s important to go through these objectives and check if they have achieved what they claim in the next section of this assignment the efficiency level of this scheme will be checked. EFFICIENCY OF AYUSHMAN BHARAT YOJANA EVALUATING ABY ‘s PROGRESS TOWARDS UNIVERSAL HEALTH COVERAGE Achievements: o As of September 2024, Ayushman cards had been issued to over 35.4 crore families in 33 states and union territories, accounting for approximately 12 crore families. This marks a significant increase from the original target of 10.74 crore families. o The scheme has authorized 7.79 crore hospital admissions, providing financial coverage of ₹1,07,125 crores. This allows many beneficiaries to  receive necessary medical treatments without incurring out-of-pocket expenses. Which was a primary goal of the initiative. o PM-JAY covered over 1,500 medical procedures, including critical surgeries and treatments for serious conditions such as cancer and heart disease, with a cashless option that lowers financial barriers for beneficiaries. o As of September 2024, over 1,74,453 Health and Wellness Centers (HWCs) had been established to improve primary healthcare access by bringing comprehensive care closer to communities. o The Ayushman Bharat Yojana (AB-PMJAY) has significantly improved healthcare access for India’s most vulnerable populations. With over 28,350 hospitals and healthcare providers enrolled, the scheme has benefited more than 519 million families by providing health coverage of up to ₹5 lakh per year for secondary and tertiary care hospitalization. Notably, it has reduced catastrophic health expenditure (CHE) among beneficiaries from 65.5% to approximately 29% after hospitalization, easing financial burdens on families. Furthermore, the establishment of 1.5 lakh Health and Wellness Centres (HWCs) is intended to improve primary healthcare services, promote preventive care, and reduce reliance on higher-tier facilities. This comprehensive approach has resulted in increased access to essential medical services at the community level. Challenges: o Despite increased access, challenges remain in ensuring the quality of healthcare services provided through the scheme. There are concerns about the sufficiency of healthcare providers, particularly in rural areas where infrastructure may still be lacking. o The challenges of identifying eligible beneficiaries and ensuring they are aware of their entitlements persist. Many potential beneficiaries may not fully understand how to enroll or use the benefits available under PM-JAY. o The shortage of healthcare professionals in rural areas may limit the scheme’s ability to provide timely and adequate care. o Despite its achievements, AB-PMJAY faces a number of challenges that limit its overall effectiveness. Many beneficiaries continue to pay out-of-pocket for diagnostics and medications that are not covered by the scheme, undermining its goal of financial protection. Implementation issues continue, with eligible beneficiaries occasionally unable to access services due to bureaucratic barriers or a lack of awareness about the scheme. Furthermore, concerns about care quality remain, as the National Health Authority (NHA)’s  quality audits lack transparency. The COVID-19 pandemic exposed flaws in India’s healthcare system and gaps in AB-PMJAY’s ability to provide critical support during crises, emphasizing the need for ongoing healthcare infrastructure and outreach efforts. EVALUATING ABY’ s PROGRESS TOWARDS FINANCIAL PROTECTION AND CASHLESS TREATMENT Achievements: o The Pradhan Mantri Jan Arogya Yojana has made significant progress in providing financial protection and cashless treatment to economically vulnerable families. According to official reports, beneficiaries’ out-of-pocket expenses have decreased significantly, with studies showing that the share of such expenses has dropped from 76.1% prior to hospital admission to 30% post-hospitalization. Furthermore, the incidence of catastrophic health expenditure (CHE) fell significantly, from 65.5% to about 29% after admission, demonstrating the scheme’s effectiveness in protecting families from financial ruin due to high medical costs. The cashless treatment mechanism enables beneficiaries to receive medical care without making initial payments, ensuring timely access to healthcare services. With a large network of empaneled hospitals throughout India, PMJAY offers comprehensive coverage for secondary and tertiary care hospitalization, including pre-existing conditions, making it more accessible to all eligible families. Challenges: o Despite these accomplishments, the Ayushman Bharat Yojana faces a number of challenges that impede its full effectiveness. Beneficiaries' awareness of the scheme remains a major issue, as many eligible individuals may not fully understand their rights or how to access services. Furthermore, implementation varies by state, resulting in inconsistencies in service delivery and care quality. Some regions may experience claims processing delays or inadequate infrastructure to handle the volume of patients seeking treatment under PMJAY. Furthermore, while the scheme's cashless treatment facilities have been expanded, there is still a need for better integration with existing healthcare services and ongoing monitoring to ensure that all eligible families fully benefit from the program.Addressing these challenges is critical  to maximizing ABY's impact and achieving its overarching goals of financial protection and improved healthcare access. EVALUATING ABY’s PROGRESS TOWARDS EMPLOYMENT GENERATION IN HEALTHCARE SECTOR Achievement: o The Ayushman Bharat Yojana (AB-PMJAY) has made a significant contribution to job creation in India's healthcare sector. The healthcare workforce has grown significantly, from 4.7 million in 2015 to an estimated 7.5 million by 2022, owing in large part to the scheme's expansion of healthcare services. This surge has created a variety of job opportunities for healthcare professionals such as doctors, nurses, and support staff. Furthermore, the initiative has indirectly created job opportunities in related industries such as pharmaceuticals, diagnostics, and medical technology, as investments in infrastructure and technology have resulted in the establishment of diagnostic centers and telemedicine services. The growth of the healthcare sector has the potential to empower women, as many nursing and community health positions are filled by women, increasing female labor force participation. Challenges : o Despite these accomplishments, a number of challenges prevent the full realization of job creation in the healthcare sector. A critical shortage of skilled professionals persists, especially in rural areas, where many qualified doctors and nurses prefer urban settings due to higher pay and working conditions. Furthermore, the sector's rapid expansion necessitates an increase in training institutions for healthcare professionals; however, issues with education and training quality can have an impact on the preparedness of new entrants to the workforce. Furthermore, job security remains a concern for many community health workers (CHWs), who are frequently hired on a contract basis without adequate pay or benefits. This situation can result in high turnover rates and employee dissatisfaction, undermining workforce stability despite the increasing number of job opportunities available.  EVALUATING ABY’s PROGRESS TOWARDS REDUCING HEALTH DISPARITIES Achievement: o AB-PMJAY aims to establish 1.5 lakh Health and Wellness Centers (HWCs) in rural areas to provide primary healthcare services closer to communities. The scheme has partnered with over 28,350 hospitals, both public and private, to ensure beneficiaries can access healthcare services near them, regardless of their location. AB-PMJAY also offers portable benefits, allowing beneficiaries to receive treatment at any location. Challenges: o Despite efforts, 35% of urban residents still do not have access to HWCs, indicating that more work is needed to ensure equitable distribution of primary healthcare services. The quality of care provided by empanelled hospitals varies, and there are concerns about the regulation and oversight of private sector participation in the scheme.Awareness of the scheme remains low in some regions, particularly among vulnerable populations, which can limit its effectiveness in reaching those who need it the most. EVALUATING ABY’s PROGRESS TOWARDS EMPOWERING WOMENS HEALTH Achievement: o One of AB-PMJAY's most notable achievements is its emphasis on maternal and child health, which is critical for improving women's health outcomes. The program includes comprehensive coverage for maternity, neonatal, and pediatric care, ensuring that mothers and children have access to critical medical services. According to reports, women account for approximately 48% of all authorized hospital admissions receiving PMJAY benefits, emphasizing the scheme's role in increasing women's access to healthcare. Furthermore, the establishment of Health and Wellness Centres (HWCs) has improved preventive care and screenings for common noncommunicable diseases (NCDs) in women, such as cervical and breast cancer. The increased presence of female healthcare providers at these facilities has encouraged more women to seek medical attention.  Challenges: o Despite these accomplishments, a number of obstacles prevent AB-PMJAY from fully realizing its potential for improving women’s health. Certain demographics, particularly those from lower socioeconomic backgrounds, continue to have low awareness of the scheme, which can limit access to available services. According to one study, while awareness was higher in some regions, a sizable proportion of eligible women remained unaware of their entitlements under the scheme. Furthermore, the quality of care provided varies across facilities, raising questions about women’s equitable access to high-quality healthcare services. These challenges indicate that while AB-PMJAY has made progress in empowering women’s health, ongoing efforts are necessary to enhance awareness, improve service quality, and ensure that all women can fully benefit from the healthcare services available under the scheme. EVALUATING ABY’s PROGRESS TOWARDS TECHNOLOGY DRIVEN BENEFICIARY IDENTIFICATION Achievement: o Digital Identity Integration: The use of digital identity solutions, such as the Aadhaar system, has greatly improved the beneficiary identification process. The scheme uses biometric authentication methods such as fingerprints and facial recognition to accurately verify beneficiaries’ identities without relying solely on physical documentation. This has streamlined the enrollment process and reduced exclusionary barriers for marginalized populations who may not have traditional ID. o Data-Driven Targeting: The use of advanced data analytics and machine learning algorithms has increased the accuracy of identifying people who need assistance. By analyzing various data points, such as income levels and geographic location, AB-PMJAY can better target resources and tailor interventions to specific needs. This data-driven approach improves resource allocation efficiency while also ensuring that assistance reaches those in greatest need. o Real-Time Monitoring and Evaluation: The use of IT platforms for transaction management and feedback mechanisms enables real-time tracking of beneficiary utilization patterns. This capability allows for quick adjustments to service delivery, increasing overall program effectiveness. Challenges : o Awareness and Accessibility: Despite technological advances, potential beneficiaries’ awareness of the scheme remains low, particularly in rural areas. Many eligible individuals continue to rely on informal channels to obtain information about their entitlements, which can impede efficient service utilization. o Fragmented Systems: Some beneficiary management systems have siloed data and limited interoperability across government departments. This fragmentation can complicate information sharing and prevent effective collaboration among stakeholders, reducing service delivery efficiency. o Data Privacy Concerns: As beneficiary identification becomes more reliant on digital solutions, concerns about data privacy and security emerge. Ensuring strong safeguards against sensitive beneficiary information is critical to maintaining trust in the system. CONCLUSION For India's economically disadvantaged communities, the Ayushman Bharat Yojana (AB- PMJAY) is a revolutionary attempt to increase healthcare affordability and access. The organisation has accomplished a number of noteworthy goals, such as providing Ayushman cards to more than 35 crore families, lowering out-of-pocket costs significantly, and opening more than 1.74 lakh Health and Wellness Centres. These achievements highlight how close the program is to achieving its main goals of providing comprehensive medical care, financial security, and universal health coverage. Despite these advances, AB-PMJAY has yet to reach its full efficiency potential. Variability in service quality, gaps in beneficiary awareness, and discrepancies in healthcare access are all ongoing challenges. Infrastructure issues in remote areas, limited coverage for key diagnostics and drugs, and administrative barriers continue to undermine the scheme's efficacy. Furthermore, while the scheme's success in creating jobs and reducing healthcare disparities has been encouraging, it still has holes that must be filled before it can reach its full potential. In conclusion, while the Ayushman Bharat Yojana has made great progress in enhancing healthcare access and financial security for millions of people, it has not yet attained full efficiency. Continued efforts are required to overcome existing difficulties and maximise the scheme’s impact, ensuring that it achieves its lofty objectives and provides equitable, high-quality healthcare to all intended recipients. REFERENCES https://nha.gov.in/PM-JAY https://pib.gov.in/Pressreleaseshare.aspx?PRID=1546948 https://www.acko.com/health-insurance/ayushman-bharat-yojana-scheme/ https://www.starhealth.in/blog/ayushman-bharat-scheme https://www.pw.live/exams/ssc/ayushman-bharat-yojana/ https://economictimes.indiatimes.com/wealth/insure/health-insurance/health-insurance- rule-change-cashless-treatment-at-any-hospital-how-to-get- it/articleshow/107124089.cms https://services.india.gov.in/service/detail/ayushman-bharat-pradhan-mantri-jan-arogya- yojana-ab-pmjay-services https://goodhealthtpa.com/?page_id=2205 https://www.business-sweden.com/insights/blog/five-pillars-of-growth-in-indias- healthcare-sector/ https://www.investindia.gov.in/sector/healthcare https://justjobsnetwork.org/events/the-growing-demand-for-healthcare-and- opportunities-for-job-creation-in-india/ https://www.niti.gov.in/sites/default/files/2023- 02/InvestmentOpportunities_HealthcareSector.pdf https://www.generation.org/news/employment-trends-and-challenges-in-the-healthcare- sector/ https://justjobsnetwork.org/events/the-growing-demand-for-healthcare-and- opportunities-for-job-creation-in-india/ https://www.businesstoday.in/latest/in-focus/story/india-can-create-12-million-jobs-by- 2030-by-investing-in-healthcare-sector-report-323703-2022-02-23