Health Sector – UHC, National Health Policy, Family Planning, Health Insurance, etc.

[pib] Ayushman Bharat Health Accounts (ABHA)

Note4Students

From UPSC perspective, the following things are important :

Prelims level: Ayushman Bharat Health Accounts (ABHA), AB-PMJAY

Mains level: NA

Why in the news?

This newscard is an excerpt from an explainer published in the PIB.

Ayushman Bharat Health Accounts (ABHA)

  • ABHA, an integral part of the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY), serves as a link for all health records of an individual.
  • It is a sub-component of the Ayushman Bharat Digital Mission launched in September 2021.
  • It is a 14-digit id employed to uniquely identify individuals, verify their identity, and connect their health records (with their consent) across various systems and stakeholders.

Features of ABHA

  • Cashless Transactions: ABHA enables cashless transactions for eligible beneficiaries, reducing the financial burden during medical emergencies.
  • Electronic Health Records (EHR): It integrates electronic health records, facilitating storage, and retrieval of patient information for streamlined healthcare delivery.
  • Portability: ABHA accounts are portable across various healthcare providers under the Ayushman Bharat scheme, ensuring seamless access to services.
  • Real-time Monitoring: Incorporating real-time monitoring mechanisms to track fund utilization, ABHA ensures efficient allocation and prevents misuse.

Various Components

  • Beneficiary Identification: ABHA involves the identification and registration of eligible beneficiaries under the Ayushman Bharat scheme, assigning a unique health identification number (UHID).
  • Funds Management: It manages the allocation and disbursement of funds for healthcare services, ensuring prompt and secure transfers.
  • Claim Settlement: ABHA processes and settles claims submitted by healthcare providers, verifying authenticity, and disbursing payments.
  • Audit and Oversight: Incorporating audit mechanisms to monitor fund utilization, ABHA ensures compliance with regulations and maintains system integrity.

Back2Basics: Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY)

Details
Umbrella Scheme
  1. Ayushman Bharat
  2. Incepted in National Health Policy 2017, to achieve the vision of Universal Health Coverage (UHC)
Launch Year 2018
Components
  1. Health and Wellness Centres (HWCs)
  2. Pradhan Mantri Jan Arogya Yojana (PM-JAY)
Pradhan Mantri Jan Arogya Yojana (PM-JAY)
  • Offers a sum insured of Rs. 5 lakh per family for secondary and tertiary care
  • Provides cashless and paperless access to services at any empanelled hospital across India
  • Portable scheme, allowing beneficiaries to avail treatment at any PM-JAY empanelled hospital
Coverage
  • 3 days pre-hospitalisation and 15 days post-hospitalisation
  • Includes diagnostic care and expenses on medicines
  • No restriction on family size, age, or gender
  • Covers all pre-existing conditions from day one
Beneficiaries Identified through Socio-Economic Caste Census (SECC) data
Funding
  • Shared funding: 60:40 for states and UTs with legislature, 90:10 in Northeast states and J&K,
  • Himachal Pradesh, and Uttarakhand, 100% central funding for UTs without legislature
Nodal Agency National Health Authority (NHA)

  • Autonomous entity under the Society Registration Act, 1860
  • Responsible for effective implementation of PM-JAY in alliance with state governments

State Health Agency (SHA)

  • Apex body of the State Government responsible for the implementation of AB PM-JAY in the State

 

PYQ:

2021:

“Besides being a moral imperative of a Welfare State, primary health structure is a necessary precondition for sustainable development.” Analyse.

 

Practice MCQ:

Consider the following statements about the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY):

1.    3 days pre-hospitalisation and 15 days post-hospitalisation.

2.    Includes diagnostic care and expenses on medicines.

3.    No restriction on family size, age, or gender.

4.    Beneficiaries are identified from national family health survey.

How many of the above discussed features is/are correct?

(a) One

(b) Two

(c) Three

(d) Four

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