THE GIST of Editorial for UPSC Exams : 22 September 2018 (New health paradigm)

New health paradigm

Mains Paper: 2 | Governance 
Prelims level: Pradhan Mantri Jan Arogya Yojana 
Mains level:  Welfare schemes for vulnerable sections of the population by the Centre and States and the performance of these schemes; mechanisms, laws, institutions and bodies constituted for the protection and betterment of these vulnerable sections

Introduction

• Ayushman Bharat is a far-reaching initiative aimed at ensuring holistic healthcare services.
• Health and wellness centres was launched on April 14 from Chhattisgarh’s Bijapur district.
• Since then, 2,287 health and wellness centres have come up around the country.

Pradhan Mantri Jan Arogya Yojana

• The Pradhan Mantri Jan Arogya Yojana (PMJAY) will be unveiled on September 23.
• It will provide a cover of Rs 5 lakh per family per year for inpatient care to 10.74 crore families at the bottom of the pyramid.
• This translates into more than 50 crore people, around 40 per cent of India’s population.
• The health conditions and surgical procedures, covered free, are encompassed in over 1,350 packages that include practically all secondary and tertiary conditions requiring hospitalisation, barring a

few such as organ transplantation.

• The services will be provided by empanelled public and private hospitals.
• Unlike private insurance schemes, PMJAY does not exclude a person on account of pre-existing illnesses.

Important highlights of this scheme

• There is also no need for formal enrolment; families that are listed with defined deprivation criteria on the Socio Economic and Caste
• Census database are automatically enrolled.
• All that is required is a proof of identity, which could be Aadhaar or any other government-issued identity card.
• All but a few states have agreed to be a part of the PMJAY.
• A strong fraud control mechanism has been conceived also an audit system has been put in place.
• Thousands of Ayushman Mitras are being trained. At each facility, one of them will receive the beneficiary, check her eligibility and facilitate in-patient care.
• A system for patient feedback and grievance redressal is also in place.
• The system will be cashless and largely paperless. A robust IT system has been put in place.
• An efficient claims management system is functional with payments to be made within two weeks.
• The Yojana will be implemented in concord with state-level schemes, if they exist.
• One unique feature of the PMJAY is its national portability once fully operational.

How PMJAY is important for India?

• PMJAY will herald a new era in healthcare for four reasons.
• It will dramatically improve provision of healthcare for the poor.
• It is now possible for a construction worker with an injured knee to have an implant for free, a rickshaw-puller with a heart attack to undergo a stent procedure and a farmer’s wife to receive full treatment for breast cancer.
• The PMAJAY will be a catalyst for transformation.
• The earnings of public hospitals under PMJAY will be available for their upgradation and also for incentivising the provider teams as these funds will be deposited with the Rogi Kalyan Samitis.
• The PMJAY is a poverty-reducing measure. Each year, six to seven crore people, above the poverty line, fall below it because of health-related expenses.
• Fourth, the scheme will create lakhs of jobs for professionals and non-professionals — especially women.

Way forward 

• It will give a boost to the health technology industry.
• The implementation of a mission of this size, ambition and complexity is hugely challenging.
• High uptake, quality care, beneficiary satisfaction, efficient operations and fraud-controlled systems are the key metrices of its success.
• There is also willingness to learn, improve and reform.

UPSC Prelims Questions: 

Q.1)  Consider the following statements about Pradhan Mantri Jan Arogya Yojana.
1.    The Pradhan Mantri Jan Arogya Yojana (PMJAY) will be unveiled on September 23.
2.    It will provide a cover of Rs 2 lakh per family per year for inpatient care to 10.74 crore families at the bottom of the pyramid.
3.    This translates into more than 50 crore people, around 40 per cent of India’s population.
Which of the statements given above is/are correct?
(a) 1 only
(b) 1 and 3 only
(c) 1, 2 and 3
(d) 2 and 3 only
Answer: B

UPSC Mains Questions:
Q.1)  How PMJAY scheme is significant for India’s healthcare system?

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