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Today onwards, nobody will be poor in India, from the health point of view. Now, all needy people will have an insurance of Rs 5 lakh with the premium paid by the government.
The Prime Minister, Shri Narendra Modi, will launch the Ayushman Bharat scheme, officially known as the Pradhan Mantri Jan Arogya Yojana (PM-JAY) today in Ranchi, Jharkhand.
The scheme will provide insurance cover of up to Rs 5 lakh per family per year at any government or empanelled private hospital all over India, for secondary and tertiary care hospitalization. More than 10 crore poor and economically deprived families and more than 50 crore people will benefit. There is no restriction on family size, age or gender. All pre-existing conditions are covered from day one of the policy. The benefit cover includes both pre and post hospitalization expenses.
All workers in India, who earn less than 21,000 INR per month are already covered under the Employees’ State Insurance (ESI) Scheme.
Getting the insurance premium paid by the government will now be a fundamental right for those who are eligible for the scheme.
All hospitals and health care establishments, who have committed 10% free work for the economically weaker section (EWS) of the society will now get paid under the scheme; also, all government hospitals will start getting some reimbursements under the scheme. So, more and more people will now opt for private wards in government hospitals.
Health is already a fundamental right under Article 21 of the constitution of India and improvement of the public health is a primary duty of the government under Article 47, under the Directive Principles of State Policy, based on the means available, which mandates the government “to raise the level of nutrition and the standard of living and to improve public health”. And, if the required means are not available, the state government can then mandate all private hospitals to enroll under this scheme.
Because all emergent health conditions will be paid for under the insurance scheme for the poor and the needy, hospitals will no more have an excuse to refuse treatment and 100% hospitals will have to comply.
Time has come for universal health coverage and to make quality health care “available”, “accessible”, “affordable” to all and also “accountable”. The Ayushman Bharat scheme is one step towards this end.
For those who can pay, it must be mandatory to get an insurance for at least Rs 5 lakh, which will become a minimum benchmark for health insurance in India.
Once 100% people are insured, health care will become affordable over time to everyone. Treatment costs will automatically reduce.
The two types of insurance (Ayushman and non Ayushman), two types of premiums, two types of packages and two types of treatment will also invariable undergo auto correction.
Dr KK Aggarwal
Padma Shri Awardee
President Elect Confederation of Medical Associations in Asia and Oceania (CMAAO)
Group Editor-in-Chief IJCP Publications
President Heart Care Foundation of India
Immediate Past National President IMA