{"id":27337,"date":"2018-10-23T13:17:23","date_gmt":"2018-10-23T07:47:23","guid":{"rendered":"https:\/\/blog.forumias.com\/?p=27337"},"modified":"2018-10-23T13:17:23","modified_gmt":"2018-10-23T07:47:23","slug":"pmjay-the-promises-and-challenges-of-a-bold-experiment","status":"publish","type":"post","link":"https:\/\/forumias.com\/blog\/pmjay-the-promises-and-challenges-of-a-bold-experiment\/","title":{"rendered":"PMJAY: The promises and challenges of a bold experiment"},"content":{"rendered":"<p><a href=\"https:\/\/www.livemint.com\/Opinion\/mq8YIWBypaEVUiSCLBRpNN\/Opinion--PMJAY-The-promises-and-challenges-of-a-bold-exper.html\">PMJAY: The promises and challenges of a bold experiment<\/a><\/p>\n<p><strong>News:<\/strong><\/p>\n<ol>\n<li>Ayushman Bharat\u2014Pradhan Mantri Jan Arogya Yojana (PMJAY), a health insurance scheme announced in the last budget, will be launched on 23 September this year.<\/li>\n<\/ol>\n<p><strong>Important Facts:<\/strong><\/p>\n<ol start=\"2\">\n<li><strong> \u00a0<\/strong>It is the most ambitious social health insurance (SHI) programme ever launched anywhere in the world.<\/li>\n<li><strong>The need for PMJAY was felt due to the following reasons:<\/strong><\/li>\n<\/ol>\n<ul>\n<li>World Health Organization recommends at least 4% of its gross domestic product (GDP) to be spent on health.<\/li>\n<li>However, the Health Ministry\u2019s National Health accounts show that total government health expenditure is only an appalling 1.1% of GDP.<\/li>\n<li>Thus, well over 70% of health expenditure is privately financed.<\/li>\n<li>More than 62% is, in fact, direct out of pocket (OOP) spending by patients as against the WHO-recommended OOP ceiling of 40%.<\/li>\n<li>Less than a quarter of India\u2019s public health expenditure is allocated to preventive care which leads to high incidence of communicable diseases.<\/li>\n<li>Moreover, there is a rising incidence of non-communicable diseases with income growth, lifestyle changes and environmental degradation, resulting in a rising total burden of disease.<\/li>\n<li>Patients are faced with ill-equipped primary health centres (PHCs), run by poorly trained staff, a broken referral system and crowded hospitals.<\/li>\n<\/ul>\n<ol start=\"4\">\n<li><strong> \u00a0About PMJAY<\/strong><\/li>\n<\/ol>\n<ul>\n<li>PMJAY will provide insurance up to Rs 5 lakh per family per year for in-patient secondary and tertiary treatment.<\/li>\n<li>It will cover over 100 million vulnerable families, which is about 500 million people, the poorest 40% of India\u2019s population.<\/li>\n<li>Treatment would be provided by empaneled public and private hospitals<\/li>\n<li>A performance-linked payment system has also been designed to incentivise hospitals to improve service quality and patient safety.<\/li>\n<li>The hospitals would be reimbursed through the appointed insurance agencies or assurance societies\/trusts or some combination of the two.<\/li>\n<li>A <strong>National Health Authority (NHA) <\/strong>has been mandated to roll out and coordinate the programme through the state governments.<\/li>\n<li>The states are responsible for empaneling the hospitals and also decide on the implementation mode whether insurance agency or assurance trust\/society or a combination.<\/li>\n<li><strong>PMJAY is actually the second tier of Ayushman Bharat<\/strong>, a two-tier scheme. It will ride on the first tier, a network of 150,000 <strong>health and wellness centres (HWCs<\/strong>) that will provide free universal and comprehensive primary health care.<\/li>\n<li>The HWCs will serve as the awareness, screening and referral link between patients and PMJAY.<\/li>\n<li>A cadre of frontline health service professionals called Pradhan Mantri Aarogya Mitras (PMAMs) are being trained to facilitate provision of treatment to beneficiaries at hospitals.<\/li>\n<li>An information technology platform has been developed by NHA consisting of a beneficiary identification system, hospital empanelment module and a transaction management system, along with robust security systems to ensure data privacy.<\/li>\n<\/ul>\n<ol start=\"5\">\n<li><strong>Challenges of PMJAY<\/strong><\/li>\n<\/ol>\n<ul>\n<li>No actual database is available to provide actual financial cost of the programme.<\/li>\n<li>Without such a database, insurance agencies cannot estimate the required premium to adequately cover the pooled risk.<\/li>\n<li>When costs escalate, the coverage caps are introduced, thereby raising the burden of OOP spending. This is called <strong>coverage erosion.<\/strong><\/li>\n<li>The private providers are pushing for high cost treatments which are not covered by SHI to enhance their profit margins.<\/li>\n<li>Implementation failure as \u00a0PMJAY will ride on the first tier of Ayushman Bharat, a network of HWCs which will be upgraded PHCs. Fixing this weak primary care foundation is more urgently needed than providing insurance for secondary and tertiary care.<\/li>\n<li>Moreover, there is missing protection for the middle class population since PMJAY will protect only the poorest 40%. This excludes the 500 million middle segment population who depend on the unorganized sector.<\/li>\n<li>PMJAY is an entitlement based scheme and people can\u2019t register on their own. So those not on the SECC 2011 cannot get benefits of the scheme.<\/li>\n<li>Exclusion of the deserving people and lack of awareness among them is the major challenge of PMJAY.<\/li>\n<\/ul>\n<ol start=\"6\">\n<li><strong>Way forward<\/strong><\/li>\n<\/ol>\n<ul>\n<li>The Thai model with excellent SHI coverage and OOP spending down to 18% is increasingly seen as global best practice.<\/li>\n<li>Not leaving patients to seek entitlement from Ayushman Mitras owing to lack of awareness, database supplied by the State Health Agency can be relied upon.<\/li>\n<\/ul>\n","protected":false},"excerpt":{"rendered":"<p>PMJAY: The promises and challenges of a bold experiment News: Ayushman Bharat\u2014Pradhan Mantri Jan Arogya Yojana (PMJAY), a health insurance scheme announced in the last budget, will be launched on 23 September this year. Important Facts: \u00a0It is the most ambitious social health insurance (SHI) programme ever launched anywhere in the world. The need for&hellip; <a class=\"more-link\" href=\"https:\/\/forumias.com\/blog\/pmjay-the-promises-and-challenges-of-a-bold-experiment\/\">Continue reading <span class=\"screen-reader-text\">PMJAY: The promises and challenges of a bold experiment<\/span><\/a><\/p>\n","protected":false},"author":61,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"jetpack_post_was_ever_published":false,"footnotes":""},"categories":[555],"tags":[],"class_list":["post-27337","post","type-post","status-publish","format-standard","hentry","category-test-1","entry"],"jetpack_featured_media_url":"","views":"","jetpack_sharing_enabled":true,"_links":{"self":[{"href":"https:\/\/forumias.com\/blog\/wp-json\/wp\/v2\/posts\/27337","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/forumias.com\/blog\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/forumias.com\/blog\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/forumias.com\/blog\/wp-json\/wp\/v2\/users\/61"}],"replies":[{"embeddable":true,"href":"https:\/\/forumias.com\/blog\/wp-json\/wp\/v2\/comments?post=27337"}],"version-history":[{"count":0,"href":"https:\/\/forumias.com\/blog\/wp-json\/wp\/v2\/posts\/27337\/revisions"}],"wp:attachment":[{"href":"https:\/\/forumias.com\/blog\/wp-json\/wp\/v2\/media?parent=27337"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/forumias.com\/blog\/wp-json\/wp\/v2\/categories?post=27337"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/forumias.com\/blog\/wp-json\/wp\/v2\/tags?post=27337"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}