Fact Checking Government claims on ‘Ayushman Bharat’
Sai Krishna Muthyanolla
April 9, 2019
The BJP government
published an infographic on the 48-months portal that makes certain claims
about the ‘Ayushman Bharat Scheme’. This article is a fact check of the claims.
The BJP government published an infographic on the 48-months portal that makes certain claims about the ‘Ayushman Bharat Scheme’. This article is a fact check of the claims.
What is Ayushman Bharat?
The first claim is that the scheme will ‘provide
comprehensive health coverage up to Rs. 5 lakh per family per year to around 50
crore people’.
The
National Health Policy  (NHP) of 2017 lays out priorities interms developing better financial protection strategies, strengtheningregulation and health assurance. This is the third revision of the policy whichpreviously existed in the form of National
Health Policy of 2002. The earliest iteration of the policy is the National
Health Policy of 1983. The latest NHP was formulated after a situation
analysis ofthe country.
Ayushman
Bharat is a National Health Protection Scheme, which is meant to cover10 crore poor and vulnerable families (approximately 50 crore beneficiaries)providing coverage up to 5 lakh rupees per family per year for secondary andtertiary care hospitalization. The eligible beneficiaries are selected usingthe SECC
deprivation criteria.
AyushmanBharat subsumes the on-going centrally sponsored schemes – Rashtriya
Swasthya Bima Yojana (RSBY) and the Senior
Citizen Health Insurance Scheme (SCHIS). The RSBY was launched inthe year 2008. The Minister of Finance, Arun Jaitley, in the budget speech of 2018-19 said that theNational Health Protection Scheme (Ayushman Bharat) will be the world’s largestgovernment funded health care program.
Theprevious schemes like the RSBY enrolled around 3.5 crore families with acoverage of Rs. 30,000 per annum. States like Andhra Pradesh & Telanganahave a functional health insurance scheme ‘Aarogyasri’, launched in the year2007. These states have not
joined theAyushman Bharat since there will be a huge reduction in the number ofbeneficiaries who are already covered under the ‘Aarogyasri’ scheme.
The website of the scheme states that ‘under the ambit of
Ayushman Bharat, a Pradhan Mantri Jan Arogya Yojana (PM-JAY) to
reduce the financial burden on poor and vulnerable groups arising out of
catastrophic hospital episodes and ensure their access to quality health
services was conceived. PM-JAY seeks to accelerate India’s progress towards
achievement of Universal Health Coverage (UHC) and Sustainable Development Goal
– 3 (SDG3). Pradhan Mantri Jan Arogya Yojana (PM-JAY) will provide
financial protection (Swasthya Suraksha) to 10.74 crore poor, deprived rural
families and identified occupational categories of urban workers’ families as
per the latest Socio-Economic Caste Census (SECC) data (approx. 50 crore beneficiaries).
It will have offer a benefit cover of Rs. 500,000 per family per year (on a
family floater basis). PM-JAY will cover medical and hospitalization
expenses for almost all secondary care and most of tertiary care procedures.
PM-JAY has defined 1,350 medical packages covering surgery, medical and day
care treatments including medicines, diagnostics and transport’.
Ayushman Bharat Yojana comprises of twocomponents namely (i) Provision of Comprehensive Primary Healthcare (CPHC)through Health and Wellness Centers (HWCs) and (ii) Ayushman Bharat PradhanMantri Jan Arogya Yojana (PMJAY). Ayushman Bharat Pradhan Mantri Jan ArogyaYojana (PMJAY) provides hospitalisation coverage up to Rs.5.00 lakh per familyper year for secondary and tertiary care procedures including certain definedpre and post hospitalisation expenses to families eligible based on specifieddeprivation and occupational criteria as per Socio Economic Caste Census (SECC)database. AB-PMJAY is an entitlement-based scheme under which coverage islinked to deprivation.
As the state governments are responsiblefor the implementation of the scheme and setting up of the hospitals and healthcare centers, it is important to note that ‘as
of February 2019, 33 States/UTs have signed Memorandum of
Understanding with National Health Agency for implementing Ayushman Bharat National
Health Protection Mission (AB-NHPM)’.
As per the latest available information,  7,91,457 claims have been submittedunder the scheme out of the 11.36 crore beneficiary families covered across thecountry.
Claim: Provide comprehensive   health coverage up to Rs. 5 lakh per family per year to around 50 crore people.
Fact: Government provides   health insurance cover of up to Rs. 5,00,000 per family per year. More than 10.74 crore poor and vulnerable families (approximately 50 crore beneficiaries) covered across the country. Hence, the claim is TRUE. As of February 2019, 7.91 lakh claims   have been submitted under the scheme.
How many health and wellness centers have been
established?
The second claim is that ‘1.5 lakh sub centers and primary health
centers being transformed as health and wellness centers (HWCs) to provide
comprehensive primary healthcare services’.
Under Ayushman Bharat Programme 1.5 lakh Health Sub Centres and Primary Health Centres are to be transformed into Health and Wellness Centres (HWCs) byDecember, 2022 in order to expand access to Comprehensive Primary Health Care(CPHC). Sub Health Centres (SHCs) and Primary Health Centres (PHCs) are beingstrengthened as Health and Wellness Centres (H&WCs). The H&WCs are toprovide preventive, promotive, rehabilitative and curative care for an expandedrange of services encompassing reproductive and child health services,communicable diseases, non-communicable diseases, palliative care and elderlycare, oral health, ENT care, and basic emergency care.
As per latest available government data, approvals for over21000 such HWCs were accorded in 2018-19 against the target of 15000 in thecurrent year. Out of these, 8120 Health & Wellness Centers have beenoperationalized so far.
As per a response in the Lok Sabha publichealth and hospitals being a state subject, it is for the states to decide the location of the HWCs. However, atleast two Health and Wellness centres are to be operationalised in eachAspirational district under extended Gram Swaraj Abhiyan.
Claim: 1.5 lakh sub centers   and primary health centers being transformed as health and wellness centers   (HWCs) to provide comprehensive primary healthcare services.
Fact: Under Ayushman Bharat   Programme 1.5 lakh Health Sub Centres and Primary Health Centres are to be   transformed into Health and Wellness Centres (HWCs) by December, 2022. Out of   this, 8120 Health & Wellness Centres have been operationalized so far. Since   the claim talks about a future target, it remains UNVERIFIED.
This story is part of a larger series on the 4-years of the Modi government. This series has been made possible with the flash grant of the International Fact Checking Network (IFCN). Read the rest of the stories in this series here