Ayushman Healthcare: Healing the souls

In this rapidly evolving world, where health has become a pressing concern and the treatment of certain diseases has grown increasingly challenging and financially burdensome, a savior has emerged in the form of the Ayushman Bharat Scheme.

It is well known fact that health insurance is essential for safeguarding one’s financial well-being, as it offers much-needed financial support in the face of unforeseen medical emergencies.

Unfortunately, in India, individuals hailing from lower economic strata and rural areas often forego purchasing health insurance policies due to financial constraints and a lack of awareness. In the context, I am quoting some lines by the philosopher Ralph Waldo Emerson:

“The first wealth is health. Sickness is the vacation of better health. The two—sickness and death— Are not life, but only its intervals.”

We all need to be hopeful and yes, it is hope that makes us lively and to aspire or dream big.

To address this issue and to save countless lives, the Ayushman Bharat Yojana, also known as the Golden Card insurance scheme was introduced a few years ago.

This program was designed to provide financial protection to individuals during hospitalization in the event of a medical emergency. It primarily targets the impoverished, vulnerable, and economically weaker sections of society.

During my recent constituency tour in the Pir-Panchal region last month, I had the opportunity to meet numerous people, many of whom expressed their gratitude for the success of the scheme.

They shared stories of how they benefited from the scheme, particularly during hospitalizations and surgeries. This experience inspired me to articulate why this scheme is of paramount importance and why everyone should consider enrolling in it.

Launched in September 2015, the scheme’s primary objective was to provide coverage to over 50 crore citizens of India, including approximately 12 crore underprivileged families, without any restrictions based on age or family size. It is worth noting that under this scheme, each family is entitled to a maximum sum insured of ₹5 lakh.

I am reminded of a story narrated by a close relative of mine who revealed how the scheme made a significant difference in his life. Last year, he underwent a cholecystectomy surgery at a reputable private hospital.

Despite being from a Below Poverty Line (BPL) background, he couldn’t have afforded such an expensive procedure. However, thanks to the Golden Health Card he possessed, he was able to receive treatment under the scheme.

He explained that, in addition to covering hospitalization expenses, the scheme also took care of diagnostic tests, medications, and pre- and post-hospitalization expenses.

It is pertinent to mention that the scheme played a pivotal role during the COVID-19 pandemic, covering not only hospitalization but also post-hospitalization expenses.

I am witness to the development that how it extended its coverage to a wide range of secondary and tertiary healthcare procedures, encompassing nearly 1400 expensive treatments including knee replacements and brain surgeries.

Additionally, the scheme provides coverage for follow-up treatments. Masses view it as an exemplary initiative that offers crucial financial protection to those who need it the most. Its success stories, like the one shared by my relative, underscore the significance of this scheme.

It has made quality healthcare accessible to a vast segment of the population that was previously underserved, making it a vital component of India’s healthcare landscape. As also recommended by the National Health Policy of 2017, the primary goal of this initiative is to realize the vision of Universal Health

Coverage (UHC), aligning with the Sustainable Development Goals (SDGs) and the core commitment to “leave no one behind.”

As a medical professional, it is imperative to underscore that the formulation of this scheme that represents a significant shift from a sectoral and segmented approach to healthcare service delivery.

Instead, it strives to provide a comprehensive, need-based healthcare service, incorporating groundbreaking interventions to holistically address the healthcare system.

This comprehensive approach encompasses prevention, promotion, and ambulatory care at the primary, secondary, and tertiary levels. In February 2018, this vision materialized with the creation of 150,000 Health and Wellness Centers (HWCs) by transforming existing Sub Centres and Primary Health Centres.

These centers were established to deliver Comprehensive Primary Health Care (CPHC) that brings healthcare closer to people’s homes. They cover a wide range of services, including maternal and child health services, non-communicable disease management, and the provision of free essential drugs and diagnostic services.

Unlike that of many developed countries, where medical treatment is not only cumbersome and costly, but the way Health and Wellness Centers in India are designed to offer an expanded array of services, effectively addressing the primary healthcare needs of the entire population in their respective areas are way down.

This expansion is intended to enhance access, universality, and equity within the community. A critical emphasis is placed on health promotion and prevention, encouraging individuals and communities to make informed choices that lead to healthier behaviors, thereby mitigating the risk of chronic diseases and morbidities.

Pertinent to mention the important component of the Ayushman Bharat initiative is the Pradhan Mantri Jan Arogya Yojna, more commonly known as PM-JAY, which was launched on September 23, 2018. It is considered the world’s largest health assurance scheme entirely funded by the government.

One of the notable challenges addressed by this initiative was the fragmented nature of benefit coverage under various government-funded health insurance schemes in India.

These schemes typically imposed an upper ceiling limit, ranging from an annual cover of INR 30,000 to INR 3,00,000 per family, which resulted in a fragmented system and that worried many in past.

However, and thanks to PMJAY that provides cashless coverage of up to INR 5,00,000 per eligible family per year for a comprehensive list of secondary and tertiary care conditions. This coverage includes all expenses associated with the treatment.

Importantly, the INR 5,00,000 benefit is offered on a family floater basis, which means it can be utilized by any or all members of the family. Notably, PM-JAY has removed the family size and age limitations found in earlier schemes, and pre-existing diseases are covered from day one.

Consequently, any eligible individual with a pre-existing medical condition can receive treatment for all such conditions under this scheme, starting from the day they enroll.

In Jammu and Kashmir, the Ayushman Bharat-PMJAY-Sehat scheme made substantial progress in as over 92% of beneficiaries, which amounts to a total of 77 Lakh population approximately have been issued ‘golden cards’ under the scheme. This initiative, known as SEHAT (Social, Endeavour for Health and Telemedicine), aims to provide health insurance coverage to all residents of the Union Territory.

Under SEHAT, residents receive free-of-cost insurance with coverage of up to Rs. 5 lakh per family on a floater basis, meaning it can be utilized by any family member.

The scheme encompasses a wide range of medical procedures, including oncology, cardiology, nephrology, and also covers pre- hospitalization and post-hospitalization expenses for up to three days and 15 days, respectively, including diagnostics and medicines.

The success of this program is evident with district-wise statistics, with Shopian in Kashmir and Rajouri in Jammu having the highest percentage of beneficiaries at 81.87% and 81.89%, respectively, demonstrating the significant impact of the scheme in improving healthcare access for the people of Jammu and Kashmir.

Proudly the initiative stands as a beacon of hope in India’s healthcare landscape, reflecting a commitment to Universal Health Coverage and the principle of leaving no one behind. Its comprehensive approach, from Health and Wellness Centers to PM-JAY, is not only transformative but also a testament to the government’s dedication to ensuring that quality healthcare reaches every citizen, regardless of their economic background. This initiative not only heals bodies but also nurtures a healthier, more inclusive future for our nation.

“In the rhythm of life, health’s the beat, without it, our symphony’s incomplete

The author is former Member of Legislative Council and a medical professional.