The Role of ABHA in Ayushman Bharat Yojana

What is the Ayushman Bharat Yojana?

The Ayushman Bharat Yojana or PM-JAY is a flagship scheme of the Indian government to achieve the vision of Universal Health Coverage (UHC). The PM-JAY aims to provide healthcare access to 12 crore families.

Launched in September 2018, this government health insurance scheme provides each individual a maximum sum insured of INR 5 lakh. This makes healthcare easily accessible to the economically weaker part of society.

With an Ayushman Bharat Yojana e-card, you can get cashless hospitalisation services at any empanelled healthcare centre across the country. This ensures seamless healthcare for all registered beneficiaries.

The scheme covers 3 days of pre-hospitalisation as well as 15 days of post-hospitalisation expenses. All previous medical conditions are covered in the scheme once you enroll. The goal is to mitigate catastrophic medical expenses making healthcare accessible to all.

What is covered under the Ayushman Bharat scheme?

Ayushman Bharat Scheme broadly covers:

• The cost of medical exams
• Treatment
• Consultation
• Non-intensive and intensive care
• Pre-hospitalisation services
• Medication
• Diagnostics
• Laboratory tests
• Accommodation
• Post-hospitalisation expenses

While comprising so many facilities, PM-JAY omits certain treatments. This includes the cost of fertility treatments, outpatient department (OPD) expenses, cosmetic surgeries, drug rehabilitation, and individual diagnostics.

Features of the PM-JAY

Let’s take a look at some of the key features of the Pradhan Matri Jan Arogya Yojana:

• PM-Jay is the largest government-sponsored healthcare scheme in the world, with over 8,19,73,363 hospital admissions since the day it was launched.
• Beneficiaries of the scheme can get cashless transactions at any empanelled public or private healthcare provider in the nation.
• Public hospitals get the same reimbursements for healthcare services as private institutes, ensuring equitability.
• There is no restriction in this scheme based on the size of the family, age, or gender, ensuring inclusivity.

Who is eligible for the Ayushman Bharat Yojana?

People applying for this scheme must belong to the following categories - SC/ST, OBC, EWS, or lower-income groups. Apart from this, there are some pre-conditions by which the beneficiaries in the rural areas are decided. Some of these are as follows:

• Families with no members between ages 16 and 59 years
• Individuals surviving on alms
• Members of primitive tribal communities
• Manual scavenger families
• Families with at least one physically challenged individual or no able-bodied adult members
• People who live in makeshift houses with no proper roof or walls
   

Living in urban areas, the following people can avail of the PM-JAY:
 

• Rag pickers
• Beggars
• Washerman
• Watchmen
• Sweepers
• Sanitation workers
• Gardeners
• Plumbers
• Cobblers
• Masons
• Construction workers
• Rickshaw pullers
• Painters
• Welders
• Drivers, conductors, cleaners, etc.

Further, the PM-JAY scheme provides medical expenses to all senior citizens above the age of 70. Irrespective of their financial status, all senior citizens above the age of 70 can benefit from health insurance of INR 5 lakh.
 

What is ABHA?

ABHA is a crucial part of the PM-JAY. ABHA stores all your medical records in a digital format, mitigating the challenge of carrying all your medical files to every doctor’s visit. The initiative was started with the view to create a comprehensive digital healthcare ecosystem.

Further, ABHA enables cashless transactions for treatments. It also manages the finances of the healthcare services under the Ayushman Bharat scheme. ABHA ensures accountability, transparency, and accessibility of funds allocated for healthcare services.

Features of ABHA

ABHA was created with the thought of providing an efficient option for storing medical records and a seamless financial framework. Here are some of the top characteristics of ABHA:

• Electronic health records (EHR): With your ABHA ID you can store and retrieve your medical data. It helps in maintaining medical histories and streamlining healthcare services.
  
• Cashless treatment: Eligible individuals can avail of cashless treatment at any of the enlisted healthcare facilities. This reduces the monetary burden on the underprivileged to some extent.
• Real-time monitoring: ABHA allows accurate monitoring of funds. This ensures the resources are allocated efficiently, prevents misuse, and optimises the distribution of healthcare resources.
• Accountability and transparency: With digital transactions and EHR, ABHA ensures clarity for the patients. This significantly reduces the scope of corruption and ensures that the funds reach the right person.
• Data-driven decisions: ABHA generates insights from data. These insights are used to make proper medical decisions, which helps address healthcare challenges effectively and improve overall healthcare quality.
   

What is the role of ABHA in the Ayushman Bharat Yojana?

ABHA plays a critical role in the Ayushman Bharat scheme. Here is a list of tasks that can be accomplished with ABHA:

1. Funds surveillance: ABHA helps allocate funds from the scheme for treatment. It securely and promptly transfers the funds to the healthcare providers.
2. Beneficiary identifier: With ABHA, eligible beneficiaries can be identified and registered for the Ayushman Bharat Yojana. Every individual who is a part of this scheme is provided an ID number to facilitate management and tracking.
3. Audit and oversight: ABHA uses auditing and oversight tools to monitor the utilisation of funds. This helps identify any discrepancies or irregularities. It ensures that healthcare providers are complying with the rules and maintaining integrity in the system.
4. Claim settlement: ABHA settles claims provided by healthcare professionals for the services they provide to the beneficiaries. It verifies the authenticity of the claim and disburses payments accordingly.
    

Summing up

Initiated with the goal to make healthcare accessible to all, Ayushman Bharat Yojana has seen many success stories, bridging the gaps that prevent economically weaker sections from accessing quality healthcare. ABHA is an integral part of the entire healthcare system ensuring that the government's funds are being allocated in the right place.

FAQs

1. What documents are needed for the Ayushman Bharat scheme?

The documents needed for the Ayushman Bharat scheme are valid ID proof (voter card, Aadhar card, etc.), income proof (income certificate, BPL certificate, etc.), and address proof (passport, ration card, etc.).
 

2. Are families under the RSBY scheme covered under PM-JAY?

Yes, families covered under the RSBY (Rashtriya Swasthya Bima Yojana) are covered under the PM-JAY scheme. This is applicable even if they are not in the Socio-Economic and Caste Census (SECC) database.
 

3. Does ABHA allow data sharing?

Yes, ABHA allows data sharing but the entire process is based on user-consent. No one (even medical practitioners) will not be able to access your medical records without your authentication.