Ayushman may cover beneficiaries of Bengal's Swasthya Sathi; state govt set to bear full cost, Pg8

Key Highlights:

• West Bengal plans to integrate beneficiaries of its state-run Swasthya Sathi scheme into the central government's Ayushman Bharat scheme.
• The state government will bear the full premium cost for approximately 2.45 crore families currently covered under Swasthya Sathi to onboard them onto Ayushman Bharat.
• This move will enable Swasthya Sathi beneficiaries to access Ayushman Bharat's national network of over 36,000 empanelled hospitals and its portability feature.
• Ayushman Bharat aims to cover around 1.43 crore poor families, elderly, and frontline workers in West Bengal, with premium costs typically shared in a 60:40 ratio between the Centre and the State.
• Both schemes provide an annual health cover of up to ₹5 lakh per family for secondary and tertiary hospitalization.

Detailed Insights:

• The integration signifies a shift in West Bengal's healthcare policy, as the state had previously withdrawn from Ayushman Bharat in January 2019.
• Ayushman Bharat, launched in September 2018, is a flagship scheme providing health insurance to the bottom 40% of the vulnerable population based on Socio-Economic Caste Census (SECC) 2011 data.
• Swasthya Sathi, launched in December 2016, is West Bengal's universal health coverage scheme, entirely funded by the state government, covering all permanent residents not under other government schemes.
• The primary benefit of this integration for Swasthya Sathi beneficiaries is enhanced access to healthcare services across India due to Ayushman Bharat's nationwide portability.
• The newly formed State Health Authority in West Bengal is actively uploading patient and hospital data to the national portal to facilitate this transition.
• This convergence aims to reduce out-of-pocket expenditure for a larger population and streamline healthcare access, aligning with the vision of universal health coverage.

Key Concepts Involved:

• Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY): A national public health insurance scheme providing health cover of up to ₹5 lakh per family per year for secondary and tertiary care.
• Swasthya Sathi Scheme: West Bengal's state-sponsored health insurance scheme offering universal health coverage of up to ₹5 lakh per family per year, fully funded by the state.
• Portability: A feature allowing beneficiaries to avail cashless treatment at any empanelled hospital across the country, regardless of their home state.
• Centrally Sponsored Scheme: A scheme where the central government provides a share of the funding, with the remaining portion borne by the state governments.