Convergence of State and Central Health Schemes: UPSC Prelims Focus – Prelims Specific

Introduction

The debate surrounding the convergence of state-specific health insurance models, such as West Bengal’s Swasthya Sathi, with the central Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY), is significant for understanding India’s fiscal federalism and the mechanics of Universal Health Coverage (UHC).

Why in News?

• Recent administrative discussions have centered on integrating beneficiaries of state-run health insurance schemes into the national Ayushman Bharat framework.
• The move aims to achieve national uniformity in healthcare coverage, allowing for seamless portability of benefits for citizens across state borders.

Static Link

• Subject: Indian Polity and Governance.
• Topic: Federalism and Centre-State Relations.
• Concept: Health is a subject under the State List (Seventh Schedule) of the Indian Constitution. However, the Union government influences health policy through Centrally Sponsored Schemes (CSS) and the mandate of the Ministry of Health and Family Welfare.
• UPSC Trap: Candidates should note that while the Centre funds many health initiatives, the primary responsibility for implementation lies with the states. UPSC often frames questions to test if the aspirant can distinguish between mandatory central implementation and cooperative state participation.

Institutional Link

• National Health Authority (NHA): The apex body responsible for implementing AB-PMJAY. It is a statutory body under the Ministry of Health and Family Welfare.
• Function: It manages the digital health ecosystem, oversees empanelment of hospitals, and ensures national portability of services.
• UPSC Trap: NHA is often confused with being an executive body or an advisory commission; it is the implementation agency for PM-JAY.

Core Prelims Facts

• Ayushman Bharat PM-JAY provides a cover of Rs 5 lakh per family per year for secondary and tertiary care.
• Beneficiary identification for PM-JAY is based on the Socio-Economic Caste Census (SECC) 2011 data.
• AB-PMJAY features portability, meaning a beneficiary can access services at any empanelled hospital across India.
• Swasthya Sathi is a state-funded health scheme in West Bengal, distinct from the central framework.

Important Terms and Concepts

• Universal Health Coverage (UHC): Ensuring all people have access to needed health services of sufficient quality without suffering financial hardship.
• Portability: The ability of a beneficiary to avail insurance benefits outside their home state.
• Convergence: The process of aligning state-specific health schemes with national standards for unified delivery and monitoring.

Bodies / Organisations / Institutions

• National Health Authority (NHA): The nodal agency for the Ayushman Bharat mission.
• Ministry of Health and Family Welfare: The nodal ministry at the Union level.

Schemes / Laws / Reports / Conventions

• Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY): The world’s largest government-funded healthcare program.
• Ayushman Bharat Digital Mission (ABDM): Focuses on creating a digital health infrastructure to support universal coverage.
• National Health Policy 2017: A guiding document for achieving the goals of healthcare accessibility and affordability.

Possible UPSC Prelims Traps

• Scheme Funding: Do not assume that all health schemes are fully funded by the Centre; many are cost-shared (CSS).
• Eligibility: PM-JAY eligibility is based on SECC 2011, whereas state schemes often use different criteria. Assuming uniform eligibility across all states is a common trap.
• Constitutional Status: Health is a State Subject; it is not a Union or Concurrent subject, though the Centre can influence it through fiscal federalism.
• Absolute terms: Avoid assuming that portability is available in every single state scheme; it is a specific feature of the central PM-JAY framework.

One-Minute Revision Notes

• Health is in the State List.
• AB-PMJAY provides Rs 5 lakh coverage per family/year.
• NHA is the statutory body implementing PM-JAY.
• PM-JAY uses SECC 2011 for beneficiary identification.
• Portability is a core feature of the central PM-JAY scheme.

Practice MCQ for Prelims

1. With reference to the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY), consider the following statements:

1. It is a centrally sponsored scheme implemented by the National Health Authority.

2. The beneficiary identification is based exclusively on the most recent Census data.

3. It allows for the portability of health benefits across the country.

Which of the statements given above are correct?

A. 1 and 2 only

B. 2 and 3 only

C. 1 and 3 only

D. 1, 2 and 3

Answer: C

Explanation: Statement 2 is incorrect because AB-PMJAY beneficiary identification is based on the Socio-Economic Caste Census (SECC) 2011, not the most recent Census. Statements 1 and 3 are correct.