National Health Protection Scheme Research Articles

IJCM_29A: Expenditure incurred by cancer patients covered under National Health Protection Scheme attending a tertiary care hospital in Mangalore

Background: Over the past decades, cancer has become the second leading cause of death and morbidities around the world, accounting for nearly 1 in 6 of the total global deaths. The cost of treatment depends on the type of cancer, the duration of treatment, the type of hospital, and whether they are covered under any health insurance. Objectives: 1. Cost of cancer treatment, before and after registration under VAS, among cancer patients attending an empanelled tertiary care hospital in South India 2. Pattern of OOPE incurred by households of cancer patients. 3. Proportion of expenditure spent on cancer treatment in comparison to the annual family income. Methodology: A hospital-based cross-sectional study was conducted in tertiary care centre among cancer patients covered under VAS, from April to May 2018. Patients who were not covered under the schemes were excluded from the study. Results: Out of the 150 cancer patients actively receiving cancer treatment, a majority, i.e., 65% of them were females. More than half of them (66%) were in the age group of 20-60 years. Only 9% of patients had additional health insurance to aid their expenditures while the rest were dependent only on VAS. The median (IQR) monthly income of the patient and family members was 153(83;293) USD. The overall median (IQR) cost was 525(230;980) in our patients. Costs before initiation of treatment under VAS constituted almost 90% of direct medical OOPE spent by the patient and his family. The overall mean OOPE in this study was 856 USD. 70% of the patients incurred a monthly cost of ≥40% of their monthly family income and 41% of the patient’s OOPE was more than 100% of their monthly family income. Conclusion: A monthly cost-to-income ratio of 240% is seen in 70% of the patients, Loans were taken and donations received to combat the expenditures. Hence VAS should reimburse the medical cost before enrolment under VAS. VAS can step up and protect its objectives by reimbursing the diagnostic costs and any long-term non-medical costs associated with the illness, as this would help reduce the OOPE by 1/3 making a huge difference to their financial status.

SOCIO- DEMOGRAPHIC PROFILE AND COST INCURRED BY THE PATIENTS ADMITTED UNDER AB-NHPM SCHEME AT A TERTIARY CARE HOSPITAL

Investmentinhealthcareisanecessarysocialinvestment. Ayushman Bharat Yojana- National Health Protection Scheme (AB-NHPM) inSeptember 2018 that was rolled out across all states/UTs in all districts of thecountry. The aim of this programme was to provide a service to create a healthyandcontentnewIndia. Objectives:To determine the socio demographic profile of patients admitted under AB-NHPM and the cost incurred by these patients during a study period of one year from November 2019 to November 2020. Methodology:Retrospectiveandprospectiveobservationalrecordstudywasconductedonpatients admitted under Ayushman Bharat category. Results:Out of 1900 retrospective patients studied and 1433 prospective group of patients majorly people belonging to lower income groups,elderly and those belonging to rural areas availed the benefit. Conclusion: Lot has been done and further more needs to be done to extend this scheme to cater to a wider range of ailments.

Developing Standard Treatment Workflows-way to universal healthcare in India.

Primary healthcare caters to nearly 70% of the population in India and provides treatment for approximately 80-90% of common conditions. To achieve universal health coverage (UHC), the Indian healthcare system is gearing up by initiating several schemes such as National Health Protection Scheme, Ayushman Bharat, Nutrition Supplementation Schemes, and Inderdhanush Schemes. The healthcare delivery system is facing challenges such as irrational use of medicines, over- and under-diagnosis, high out-of-pocket expenditure, lack of targeted attention to preventive and promotive health services, and poor referral mechanisms. Healthcare providers are unable to keep pace with the volume of growing new scientific evidence and rising healthcare costs as the literature is not published at the same pace. In addition, there is a lack of common standard treatment guidelines, workflows, and reference manuals from the Government of India. Indian Council of Medical Research in collaboration with the National Health Authority, Govt. of India, and the WHO India country office has developed Standard Treatment Workflows (STWs) with the objective to be utilized at various levels of healthcare starting from primary to tertiary level care. A systematic approach was adopted to formulate the STWs. An advisory committee was constituted for planning and oversight of the process. Specialty experts' group for each specialty comprised of clinicians working at government and private medical colleges and hospitals. The expert groups prioritized the topics through extensive literature searches and meeting with different stakeholders. Then, the contents of each STW were finalized in the form of single-pager infographics. These STWs were further reviewed by an editorial committee before publication. Presently, 125 STWs pertaining to 23 specialties have been developed. It needs to be ensured that STWs are implemented effectively at all levels and ensure quality healthcare at an affordable cost as part of UHC.

Healthier mind builds healthier nation under ABArK

Background: The State of Karnataka launched a scheme called “Arogya Karnataka” as a part of universal health coverage following the Karnataka Integrated Public Health Policy 2017 and Karnataka Vision 2025 document. With the goal of achieving universal health coverage (UHC), Karnataka, a national leader in healthcare, launched the Arogya Karnataka scheme in March 2018. It was later integrated with the government of India's national health protection scheme Ayushman Bharat Pradhan Mantri Jan Arogya Yojana(AB-PMJAY) to help with financial protection. Mental health, as defined by the World Health Organization (WHO), refers to “a state of well-being in which the individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to his or her community”. Methods: A cross-sectional analysis of data collected from the State Health Agency, Suvarna Arogya Suraksha Trust (SAST) portal. The study was conducted for a period 12 months from January to December 2022. Results: The study included 7292 mental disorder patients, majority of were male (70.95%), having age group of 31-45 years (45.41%), and belonged to the Below poverty line (BPL) (94.54%). Majority of cases were psychoactive substance use (64%) followed by Schizophrenia (22%) and Mental Retardation (14%). Conclusions: Ayushman Bharat –PM-JAY Arogya Karnataka (AB-PMJAY ArK) has potential to reduce the out of pocket expenditure, distress financing and reduce catastrophic health expenditure which will lead to significant impact on health indices.

KNOWLEDGE AND UTILIZATION OF “PRADHAN MANTRI JAN AROGYAYOJANA-AYUSHMAN BHARAT” (PMJAY-AB) SCHEME AMONG THE ELIGIBLE FAMILIES IN SELECTED RURAL COMMUNITY LUCKNOW

Ayushman Bharat yojana have two inter-related components, which are Health and wellness center (HWCs) and Pradhan Mantri Jan Arogya Yojana (PM-JAY). Pradhan Mantri Jan Arogya Yojana is the National health protection scheme introduced on 23 September 2018 by the government of India targeting poor, socioeconomically weaker and disadvantaged families. It is a centrally sponsored scheme funded by both the union government and the state. This scheme is offering services to 50 crore re people with world's largest government sponsored healthcare program. The study was initiated to assess the knowledge and utilization of “Pradhan Mantri Jan Arogya YojanaAyushman Bharat” (PMJAY-AB) scheme among the eligible families of selected rural community Lucknow. The objective of the study was to assess the knowledge and utilization of PMJAY-AB scheme among the eligible families of selected rural community in Lucknow and to correlate the knowledge with the utilization of PMJAY-AB scheme. Non experimental descriptive survey research design was used by using convenience sampling technique to collect the data from 150 samples through structured questionnaires. Finding of the study reveals that the majority of people 58 (38.67%) had moderate adequate knowledge, 49 (32.67%) had an inadequate knowledge and, only 43(28.67%) people had an adequate knowledge regarding PMJAY-AB scheme. Utilization rates reveals the majority of people 90.67% are poorly utilizating the scheme while 6.67% had average utilization and only 2.67% people are utilizing the full services covered under the PMJAY-AB scheme. Hence the study concludes that the community people needs awareness regarding the Pradhan Mantri Jan ArogyaYojana-Ayushman Bharat” (PMJAY-AB) scheme to ensure full coverage.

Facilitating Cancer Care Through Ayushman Bharat Scheme (PMJAY) in Rural Places of India: A Narrative Review


 Pradhan Mantri Jan Arogya Yojana (PMJAY) also known as Ayushman Bharat or flagship National Health Protection Scheme is funded by the Government of India. The scheme takes into account not only the poor but rural families also, and that is why it is economically beneficial to the poor households in rural and urban areas. Either due to lack of funds or due to paucity of health care facilities at adjacent centres, cancer care in rural areas has always been suboptimal. Poor people are almost always on the verge of facing economic toxicities during cancer diagnosis, treatment or rehabilitation. Despite various available regional and national programs for healthcare in India, lack of insurance scheme was an inseparable problem. Ayushman Bharat scheme provides financial protection for access curative care at secondary and tertiary levels through engagement with both public and private sector. Pradhan Mantri Jan Arogya Yojana (PM-JAY) and Health and Wellness Centres (HWCs) are the two major components. Ayushman Bharat provides India with a great opportunity to improve the quality of health-care delivery by linking reimbursements directly to adherence to evidence-based management guidelines. Newer modalities of radiotherapy, chemotherapy and other biological therapies have been included under this scheme. Removes the burden of out of pocket expenditures. In Spite of multiple benefits PMJAY is not out of fallacies. Paucity of health care services, difficulties with implementation, failure in compensating associated indirect costs are the major drawbacks. Opportunities like delivering affordable and equitable cancer care in India, digitalization, removing heterogeneity across rural and urban India are the future perspectives. To conclude, if PMJAY can overcome these shortcomings, and also incorporate a hospital cash component, it could genuinely claim to be the world’s largest and most successful national health protection scheme.

Road to universal health coverage: unique model of Karnataka, India

With the goal of achieving universal health coverage (UHC), Karnataka, a national leader in healthcare, launched the Arogya Karnataka scheme in March 2018. It was later integrated with the government of India's national health protection scheme Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) to help with financial protection for accessing curative care at the secondary and tertiary levels through collaboration with the public and private sectors. The AB-PMJAY is a rare opportunity to enhance the health of hundreds of millions of Indians and get rid of a significant cause of the country's poverty. The study intends to define the State's distinctive characteristics with relation to AB-PMJAY-ArK and to highlight the State's top initiatives through the scheme. Karnataka has a unique scheme even if it is integrated due to various striking features. The country has an opportunity to address persistent and deeply ingrained issues with governance, quality assurance, and stewardship owing to AB-PMJAY-ArK. The complete approach used by the AB-PMJAY-ArK cell of the department of health and family welfare, government of Karnataka has enhanced the performance of public health institutions and can be adopted as a model by all the Indian States. Access to care, compliance, and timely assistance have all drastically enhanced. This has improved national health indices, but more crucially, it has led to the development of a bigger and stronger public health system, leading the road to UHC.

Implementation barriers and remedial strategies for community-based health insurance in Bangladesh: insights from national stakeholders

BackgroundCommunity-based health insurance (CBHI) is a part of the health system in Bangladesh, and overcoming the obstacles of CBHI is a significant policy concern that has received little attention. The purpose of this study is to analyze the implementation barriers of voluntary CBHI schemes in Bangladesh and the strategies to overcome these barriers from the perspective of national stakeholders.MethodsThis study is exploratory qualitative research, specifically case study design, using key informant interviews to investigate the barriers of CBHI that are faced during the implementation. Using a topic guide, we conducted thirteen semi-structured in-depth interviews with key stakeholders directly involved in the CBHI implementation process. The data were analyzed using the Framework analysis method.ResultsThe implementation of CBHI schemes in Bangladesh is being constrained by several issues, including inadequate population coverage, adverse selection and moral hazard, lack of knowledge about health insurance principles, a lack of external assistance, and insufficient medical supplies. Door-to-door visits by local community-health workers, as well as regular promotional and educational campaigns involving community influencers, were suggested by stakeholders as ways to educate and encourage people to join the schemes. Stakeholders emphasized the necessity of external assistance and the design of a comprehensive benefits package to attract more people. They also recommended adopting a public–private partnership with a belief that collaboration among the government, microfinance institutions, and cooperative societies will enhance trust and population coverage in Bangladesh.ConclusionsOur research concludes that systematically addressing implementation barriers by including key stakeholders would be a significant reform to the CBHI model, and could serve as a foundation for the planned national health protection scheme for Bangladesh leading to universal health coverage.

Health Care Equity: An Analysis of Ayushman Bharat: A National Health Protection Scheme in India

Health Care Equity: An Analysis of Ayushman Bharat: A National Health Protection Scheme in India

Awareness and Readiness To Implement the Pradhan Mantri Jan Arogya Yojana: A Cross-Sectional Study Among Healthcare Workers of a Tertiary Care Hospital in Eastern India.

BackgroundThe Indian government announced "Ayushman Bharat" for a New India 2022 during the 2018-19 parliament budget sessions, which includes the national health protection scheme presently known as "Pradhan Mantri Jan Arogya Yojana (PMJAY)" to facilitate access to secondary and tertiary healthcare services. This study aimed to see how well healthcare workers (HCWs) understood the PMJAY and how prepared they were to administer it.Materials and methodsWith an anticipated sample size of 411, this hospital-based analytical, cross-sectional study was done among treating faculty, resident doctors, and nursing officers as study participants. Participants completed a self-administered, pre-tested, semi-structured questionnaire to determine their level of awareness and readiness to adopt PMJAY. SPSS Version 22 software (SPSS Inc., Chicago, IL, USA) was used to analyze the data.ResultsThe overall mean (SD) awareness score and mean readiness score among HCWs were found to be 5.52 (1.82) and 18.49 (4.5), respectively. There was a significantly high awareness score among doctors compared to nursing officers. The relation between awareness score and readiness score showed a weak positive significant correlation (r=0.174, p=0.001). The linear regression model demonstrated an increase of 0.432 units in readiness for every unit increase in awareness score.ConclusionThe doctor's mean awareness score was little over half of the maximum attainable score. Faculty members were more aware of the scheme than the residents and nursing officers. The readiness to implement PMJAY improves as the awareness grows. Frequent workshops on PMJAY for stakeholders are required for better readiness.

Coverage, utilization, and impact of Ayushman Bharat scheme among the rural field practice area of Saveetha Medical College and Hospital, Chennai.

Introduction:Ayushman Bharat scheme, otherwise called as Pradhan Mantri Jan Arogya Yojana (PMJAY), is a National Health Protection Scheme introduced on 23 September 2018 by the government of India to aid the economically disadvantaged families.Aim:The study was initiated to estimate the coverage, utilization, and impact of Ayushman Bharat scheme in the rural field practice area of Saveetha Medical College and Hospital, Chennai.Settings and Design:This is the cross-sectional study conducted in the rural field practice area of Saveetha Medical College and Hospital, Chennai.Methods and Material:This cross-sectional study done among 300 households in Mappedu region of Thiruvallur district, Tamil Nadu. Simple random sampling was done to choose the study participants to reach the sample size of 300. Data was collected using semi-structured questionnaire. After the entry of data, the descriptive statistics was presented in frequency tables and graph.Result:The study found that out of 300 households only about 42.33% of the households were covered under Ayushman Bharat scheme. Among the households covered under Ayushman Bharat scheme, 47.24% households have availed Ayushman Bharat scheme in the past 1 year and only 10% of those availed the scheme has spent additional amount for health care. Around 39.88% of the households not having Ayushman Bharat scheme has faced financial burden because of health care expenditure.Conclusion:Creating awareness, appropriate governance, and working toward quality assurance, prompt referral pathways in both public and private healthcare providers can make Ayushman Bharat scheme effective.

Awareness and readiness of health care workers in implementing Pradhan Mantri Jan Arogya Yojana in a tertiary care hospital at Rishikesh.

BackgroundRight to health is one among the important components of basic human rights. The Government of India had announced “Ayushman Bharat for a new India-2022”, during 2018-19 parliament budget sessions with two components namely, Health and wellness centers for strengthening primary care and national health protection scheme now known as “Pradhan Mantri Jan Arogya Yojana (PMJAY)” for enabling access to secondary and tertiary healthcare services. Current study was conducted to assess awareness and readiness of the health care workers in implementation of Pradhan Mantri Jan Arogya YojanaMaterials and MethodsA hospital based cross sectional study was conducted with estimated sample size calculated of 236, with treating consultants and residents as study participants. Participants filled a self-administered pretested semi-structured questionnaire to assess the level of awareness and readiness in implementing PMJAY. Data was entered and analyzed using EPI Info 7 software.ResultsTotal number of participants were 181. Mean awareness score was 4.5±1.96 and mean readiness score was 16±5. Mean awareness and readiness score among medical and surgical branches was not statistically significant. There was significantly high awareness score among faculty as compared to senior residents. Relationship between awareness and readiness was found to be correlated with Pearson’s correlation of 0.206 and was statistically significant. Linear regression model demonstrated an increase of 0.531 units in readiness for every unit increase in awareness score.ConclusionMean awareness score of doctors was just around half of maximum possible score. Awareness is more among faculty members than residents. With increase in awareness there is an increase in readiness among the study population. There is a need to organize workshops on PMJAY for stakeholders.

Current State of Healthcare in India: A Critical Appraisal of the National Health Protection Scheme and Way Forward

Current State of Healthcare in India: A Critical Appraisal of the National Health Protection Scheme and Way Forward

Current State of Healthcare in India: A Critical Appraisal of the National Health Protection Scheme and Way Forward

Current State of Healthcare in India: A Critical Appraisal of the National Health Protection Scheme and Way Forward

Health and Wellness Centre for Better Health Care Delivery System in India: A Mirage or a New Hope Glass

India is the hub of national health schemes and is now first country by implementing the world’s largest national health protection scheme i.e. Ayushman Bharat Yojana...

‘Ayushman Bharat is a Boon for the Country’: Against the Motion

Background: Ayushman Bharat, came into existence in 2018, was based on recommendations of National Health Policy 2017 with an aim to provide Universal Health Coverage to citizens of India. Under this, two inter-connected components were envisaged namely, Health and Wellness Centres and National health protection scheme. But since its inception, there has been concerns with its implementation throughout the country. Objectives: This article primarily identifies the lacunaes in framework and implementation of Ayushman Bharat across the nation. The secondary objective was to study the potential consequences of this scheme on health care infrastructure of country. Result: There is a shortfall of about 20% Sub centres and an equal number of Primary health centres in India and almost 90% of existing ones do not meet Indian Public health standards. This coupled with shortage of manpower is a crucial barrier in concept of HWCs. Inadequate and incomplete coverage of health services with exclusion of outpatient services, ambiguity in beneficiary definitions and concerns related to reports of frauds might affect NHPS implementation. Insufficient financial allocation is a key obstacle for successful implementation of AB. This scheme might lead to compromise in other health related programmes. Conclusion: Without addressing existing deficiencies in health care system, mere introduction of a new comprehensive scheme might fail to achieve its objectives. There is a need to address these gaps first to get the expected results and improve health outcomes in country.

‘Ayushman Bharat is a Boon for the Country’: For the Motion

Ayushman Bharat approved by the Indian government in March 2018, is an ambitious reform to the Indian health system to provide Comprehensive Primary Health Care (CPHC) and to achieve Universal Health Coverage. The Ayushman Bharat with two components intends to provide a continuum of care services across the three-level of care, expanded service delivery through population enumeration and empanelment of Families at HWC and also expanded the range of preventive, promotive, curative, diagnostic, rehabilitative and palliative care services. There is sufficient evidence available that strengthening of primary healthcare is the most appropriate approach to achieve UHC. Investment on comprehensive primary healthcare system is a practical and affordable solution for India. The concept of Mid-Level Health Provider (MLHP) is newly introduced to improve Sub center and PHC resource utilization. Health and wellness centers with referral services provide preventive, promotive, curative, rehabilitative and palliative aspects with the inclusion of non-communicable disease and other important component will make the programme to deliver Comprehensive health care. With the availability of extensive potentially trainable human resources at comparatively low cost, the Health services of the programme are provided with the Human resource incentives. Ayushman Bharat National Health Protection Scheme will be implanted in conjunctions with the existing state insurance scheme, will provide a cashless benefit for identified secondary/ tertiary treatments, in public/ empaneled private facilities all over India without any cap on family size and age, beneficiaries being identified on the basis of Socio-Economic Caste Survey (SECC) 2011. The Utilization of manpower under Ayushman Bharat is proved by successful engagement and potential usage of nearly 1 million ASHA under the National Health Mission (NHM). The programme provides an innovative initiative of building a highly impactful health model with low cost with the utilization of skilledworkforce. This review describes why Ayushman Bharat is a boon for the country.

“Living long in India”– India’s progress towards Universal Health Coverage

Abstract Issue There are multiple small health insurance schemes throughout India. However, high out-of-pocket (OOP) expenditures, unaffordable and inequitable access to healthcare services still persist. In an attempt to address these issues and achieve Universal Health Coverage (UHC), India launched the healthcare scheme ‘Ayushman Bharat’ (“long live India”) in 2018. Description The Ayushman Bharat (AB) scheme has two components which include 1) transforming the existing primary healthcare centers (PHC) under the control of State Governments and 2) the National Health Protection Scheme (NHPS) also known as “ModiCare” - a health insurance. The scheme aims to transform nearly 150.000 PHCs to deliver comprehensive primary healthcare services across the country by 2022. NHPS covers the costs of almost all secondary and many tertiary care procedures of about 40% of the total Indian population. The coverage will be approximately €6.400 per year per beneficiary family; 60% of the costs are borne by the Centre and 40% by the States. Results Approximately €127 million have already been allocated by the Centre towards the AB scheme for the fiscal year 2018-19. Till date, around 29 million health insurance cards have been issued, approximately 1,8 million beneficiaries have been admitted and around 15.291 hospitals have been empaneled under NHPS. However, there is no data available validating the usage of the health services yet. Few Indian states are yet to implement the AB scheme. Lessons For the first time, attempts have been made to provide affordable healthcare services to the Indian population under a single common initiative. However, the AB scheme fails to cover outpatient health services, which are an important part of OOP expenses in India. Main message The effort to launch Ayushman Bharat in a big, democratic and diverse country like India has to be lauded, which not only aims to make healthcare services affordable but also aligns itself to the concept of UHC.

Ayushman Bharat National Health Protection Scheme: an Ethical Analysis.

The Ayushman Bharat (Hindi for "India blessed with a long life") scheme is a government health insurance program that will cover about 100 million poor and vulnerable families in India providing up to INR 0.5 million per family per year for secondary and tertiary care hospitalization services. In addition, it also proposes to establish 150,000 health and wellness centers all over the country providing comprehensive primary health care. The beneficiaries of the hospital insurance scheme can avail health care services from both public and empanelled private health facilities. This scheme is one of the largest government-sponsored health insurance schemes in the world. Previous experience with government-financed health insurance schemes in India has shown that they are inequitable, inefficient, and do not provide financial protection. There is a lack of clarity on the budgetary provisions over the years when the utilization is likely to increase. The Ayushman Bharat scheme in its current form strengthens the "for profit" private health sector, requiring greater emphasis on its regulation. The scheme, which has primary, secondary, and tertiary care components, places a great focus on the secondary and tertiary care services and requires more investment in comprehensive primary health care. The potential problems of "profit-motivated" supplier-induced demand by private health care providers and corrupt practices are possible ethical burdens of the scheme. For the Ayushman Bharat to meet the ethical principle of justice, it should first address universal coverage of comprehensive primary health care and move on to hospital insurance in a progressive manner. The scheme should have provisions to strictly regulate secondary and tertiary care hospitalization in the private health sector to prevent misuse. It is the ethical responsibility of the government to ensure a strong and robust public health system, but the current provisioning of the Ayushman Bharat scheme does not do this and the reasons for this are explained in this paper.

Health Reform as Political Instrument: Achieving Universal Health Coverage

India constitutes nearly one-fifth of the world’s population. People living in different parts of the country and states differ in their ethnic origin, culture, religious beliefs and other ways that influence their health status. An effective and efficient health care delivery system is indispensable. India has to focus on ever-evolving healthcare needs of its population. Affordability of quality care is a major issue. In India a large number of people still live below poverty line, the affordability of quality care needs to be addressed. With the rise in awareness, affordability and lifestyle diseases, healthcare is one of the essential needs of the nation. Launching of National Health Protection Scheme (NHPS) is a step in the right direction. The NHPS will be effective from 25 September 2018 as a political instrument towards achieving Universal Health Coverage. This is the world’s largest health insurance scheme covering nearly 40 percent of India’s population. Its success will depend on how well the plan is defined and implemented on the ground level. Primary care has to make affordable and accessible to all. It will improve the wellness of the population and reduce the overall cost to the exchequer. Interdisciplinary approach to healthcare underscores the importance of applying integrative strategies to the practice of health sciences. Continued progress and a large public-sector role in health systems reform are crucial. If effectively implemented, the NHPS is expected to make a substantial difference in the Indian health care system over the next decade. Being the largest health insurance plan, from a global perspective, its vision is to cover 50 crore poor and vulnerable beneficiaries.