The document summarizes the Ayushman Bharat Yojana (ABY) health insurance program in India. It has two main components: (1) creating 150,000 Health and Wellness Centers to provide comprehensive primary healthcare, and (2) the Pradhan Mantri Jan Arogya Yojana (PM-JAY) which provides health insurance coverage to over 100 million poor families for hospitalization costs up to $7,000 per year. The goals of ABY are to reduce out-of-pocket healthcare expenses, improve access to quality care nationwide, and mitigate the financial risks of illnesses for vulnerable populations.

1. Presented By:-
Soumya Priyadarshini
MHA 2020-22
2nd Semester

2. CONTENTS
• Introduction
• Rationale
• Aim
• The Initiatives
• Quality of Care
• Immediate Next Steps
• Key Areas for Priority
Action
• Benificiary Level
• Important Dates
• Health System
• Report Card
• Survey
• More Information
• At a Glance

3. INTRODUCTION
• Ayushman Bharat Yojana or Ayushman Bharat – Pradhan
Mantri Jan Aarogya Yojana (AB-PMJAY).
• Ayushman Bharat is a fundamental restructuring of the
manner in which beneficiaries access healthcare services
at the primary, secondary and tertiary care levels.
• It represents a transition from segmented, sectoral and
fragmented program implementation models towards a
comprehensive, holistic, need-based healthcare system.

4. INTRODUCTION
• It encapsulates a progression towards promotive,
preventive, curative, palliative and rehabilitative aspects
through access of Health and Wellness Centers (HWCs)
at the primary level.
• It provides provision of financial protection for access of
curative care at the secondary and tertiary levels through
engagement with both public and private sector.

7. RATIONALE
• Healthcare in India is largely underpenetrated with
government expenditure at around 1.25% of the
GDP(Gross Domestic Product).
• Nearly 55-60 million Indians are pushed into poverty
every year to meet medical needs.
• The hospitalisation expenses for critical ailments had shot
up by 300 per cent over a decade.
• An estimated 6 million families sink into poverty each year
due to hospitalisation.

8. AIM
Ayushman Bharat aims to undertake
path breaking interventions to
holistically address health( covering
prevention, promotion and ambulatory
care), at primary, secondary and
tertiary.

11. THE INITIATIVES
• Health and Wellness Centre
1. The first component, pertains to creation of 1,50,000
Health and Wellness Centres.
2. Comprehensive Primary Health Care (CPHC), covering
both maternal and child health services and non-
communicable diseases, including free essential drugs and
diagnostic services.
3. The first Health and Wellness Centre was launched by
the Hon’ble Prime Minister at Jangla, Bijapur, Chhatisgarh
on 14 April 2018.

13. THE INITIATIVES
• National Health Protection Scheme
1. The second component is the Pradhan Mantri Jan
Arogya Yojana (PM-JAY).
2. It provides health protection cover to poor and
vulnerable families.
3. About 62.58% of our population has to pay for their
own health and hospitalization expenses and are not
covered through any form of health protection.

14. QUALITY OF CARE
• Key principles -
 Provision of Patient Centred Care
Enable Patient Amenities at HWC
Adhere to standard treatment guidelines and clinical protocols
for care provision
Achieve Indian Public Health Standards with regards to HR,
infrastructure, equipment, service delivery and supplies:
• National Quality Assurance Standards for HWCs will be
developed
• Patient satisfaction to be captured through IT systems

15. IMMEDIATE NEXT STEPS
• Strengthen Programme Management (2 consultants in small states and
3-5 in big states as per requirement)
• Establish technical support from Training institutions/ Research
Organizations / SHSRC(State Health System Resource Centre)/ Medical
College
• Based on annual Targets of HWCs- commensurate selection/ enrolment
in IGNOU Certificate Programme in Community Health
• Completion of training of ASHAs, MPWs, PHC Staff-Medical Officers
and Staff Nurses in NCD
• Undertake gap analysis against the requirement of
equipment/medicines/ consumable.
• Roll out of IT Systems and Training of Providers in NCD App/MO Portal

16. KEY AREAS FOR PRIORITY ACTION
• Appoint Senior State Nodal Officer : Director/Additional Director/Joint
Director level officer
• Periodic reviews by Principal Secretary at all levels
• Road Map for converting all SHCs to HWCs by Dec,2022
• Annual Plans for financial year 19-20, 20-21, 21-22 and 2022-23 (up to
December,2022)
• Prioritizing Aspirational Districts/ NPCDCS( National Programme for
Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and
Stroke) Districts
• Resources Mobilization from non –Health sources

17. BENEFICIARY LEVEL
• Government provides health insurance cover of up to Rs.
5,00,000 per family per year.
• More than 10.74 crore poor and vulnerable families
(approximately 50 crore beneficiaries) covered across the
country.
• All families listed in the SECC(Socioeconomic Caste Census)
database. No cap on family size and age of members.
• Priority to girl child, women and senior citizens.
• Free treatment available at all public and empanelled private
hospitals in times of need.

18. BENEFICIARY LEVEL
• Covers secondary and tertiary care hospitalization.
• 1,350 medical packages covering surgery, medical and day
care treatments, cost of medicines and diagnostics.
• All pre-existing diseases covered. Hospitals cannot deny
treatment.
• Cashless and paperless access to quality health care services.
• Hospitals will not be allowed to charge any additional money
from beneficiaries for the treatment.
• Eligible beneficiaries can avail services across India, offering
benefit of national portability.

22. IMORTANT DATES

23. HEALTH SYSTEM
• Ensure improved access and affordability, of quality
secondary and tertiary care services through a
combination of public hospitals
• Significantly reduce out of pocket expenditure for
hospitalization.
• Mitigate financial risk arising out of catastrophic health
episodes and consequent impoverishment for poor and
vulnerable families.

24. HEALTH SYSTEM
• Enhanced used of evidence based health care and cost control for improved
health outcomes.
• Strengthen public health care systems through infusion of insurance
revenues.
• Enable creation of new health infrastructure in rural, remote and under-
served areas.
• Increase health expenditure by Government as a percentage of GDP.
• Enhanced patient satisfaction.
• Improved health outcomes.
• Improvement in population-level productivity and efficiency
• Improved quality of life for the population

26. PM-JAY Report Card: Good Momentum has been created…
26
26
10.3 Crore
Beneficiaries Verified
44 lakh worth Rs. 6,805 crores
Hospital Admissions
18,235+
Hospitals Empanelled
41,000+
Portability cases

27. 27
Not Signed the MoU or Have
Withdrawn
Status
Telangana Ongoing Discussion
Odisha Ongoing Discussion
Delhi No response received
West Bengal Withdrawn
Some States are yet to roll-out PM-JAY…
All other 32 States/UTs are implementing PM-JAY.

28. Information
TO REGISTER FOR
AYUSHMAN BHARAT
MISSION:-
www.pmjay.gov.in
Registration Form

29. AT A GLANCE..
Programmee - Ayushman Bharat Yojana
Type of project - Health insurance
Country - India
Ministry - Ministry of Health and Family Welfare
Launched - 23 September 2018
Budget - $ 1.43 billion
Status check - Active
Website - https://www.pmjay.gov.in/