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Ayushman Bharat - Taking Healthcare Services to the Grassroots Modi Government wants to revolutionise healthcare in India, Let's examine what is all about

By Dr. Dharminder Nagar

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In February, the central government announced an ambitious, nationwide healthcare scheme in primary, secondary and tertiary care systems, named "Ayushman Bharat'. In the lines of the famous "Obamacare' program in the United States, a section of media has termed this scheme as "Modicare' after our prime minister. Working on a combination of a national health protection scheme and a network of health and wellness centers across India, the program aims to bring 10 crore families under the cover of formal healthcare. The other government-run healthcare schemes such as Rashtriya Swasthya Bima Yojana (RSBY) and the Senior Citizen Health Insurance Scheme (SCHIS) will come under this flagship project when Prime Minister Narendra Modi announces it this Independence Day.

Making cashless treatment affordable to the less privileged

In an attempt to reach out to the poorest sections of India, the national health protection scheme will have a defined benefit cover of Rs. 5 lakh per family per year, with no restriction on the number of family members. This will provide a massive boost to the families living beyond poverty level who have no access to the private healthcare system that, though fills the gap of government infrastructure, costs them a fortune. Without insurance, they end up paying from their own limited means (out-of-pocket expenditure), pushing them further into poverty. In fact, a Brookings India research based on the National Sample Survey Office (NSSO) figure shows serious or chronic diseases attracting high expenditure pushed nearly 7 per cent of Indian households below the poverty line between 2004 and 2014. In fact, the 1,354 treatment packages including coronary bypass, knee replacements and stenting under the scheme are priced at a rate that is 15-20% cheaper than the Central Government Health Scheme (CGHS) rates.

The nationwide rollout of Ayushman Bharat aims to cover 40 per cent of India's population with the help of private healthcare providers. The quality healthcare provided by qualified doctors and specialists in these hospitals has been restricted only to cities. The provision in Ayushman Bharat to empanel private hospitals makes them a complementary service provider instead of a competition to the government health facilities. The suggestion to incentivize National Accreditation Board for Hospitals & Healthcare Providers (NABH)-certified private hospitals offering basic and advanced medical care and participating in the scheme will also improve penetration of healthcare establishments in the rural and remote areas.

The proposal to establish 24 new government medical colleges and hospitals by upgrading existing district hospitals is another welcome move. It will ensure at least 1 medical college for every 3 Parliamentary constituencies and at least 1 government medical college in each state, bolstering the existing medical education system. In due time, it will also help expand the pool of talent in the medical sector – a reality that is not very distant given the demand and supply dynamics in the field. Setting up 1.5 lakhs health and wellness center is also a part of this massive program providing comprehensive healthcare, including for non-communicable diseases as well as maternal and child health services, free essential drugs and diagnostic services. A whopping Rs. 1200 crore has been earmarked for this purpose. The government is also hopeful that the program will create lakhs of job opportunities, especially for women.

Not without some doubts

The biggest question that stares at this grand design is the source of funds, an area that was not addressed in the speech by the Union Finance Minister during his budget speech where he announced the scheme. India's performance in public health schemes have not been very upbeat – it was approximately 1.3 per cent of the Gross Domestic Product (GDP) between 2008 and 2015, and increased to 1.4 per cent in 2016-17. By 2025, India aims to spend 2.5 per cent of GDP in public healthcare.

A National Institution for Transforming India (NITI) Aayog report in 2017 noted that low-income states with low revenue capacity spend significantly lower on social services like health. That can raise eyebrows for the economic model of Ayushman Bharat is collaboration between the federal government and the state governments wherein the expenditure incurred in premium payment will be shared between these two parties. Besides, the states have to rope in State Health Agency (SHA) to implement the scheme. This can further put strain on the state's economy, especially the smaller states.

While the scheme provides for cashless facility for in-patient treatment and hospitalizations, it overlooks the fact that a patient from the BPL family will avoid it all cost – most of them are daily wage earners and a day of hospitalization means loss of income.

The entire system of payment under Ayushman Bharat is cashless and paperless. While the insurance companies are wary of the cyber fraud and establishing identities of the beneficiaries, the common man is apprehensive if the help will reach them on time – the notorious pace in which the government departments function is legendary. Last, but not the least, is the scarcity of human resources and supplies. According to data, 7 per cent of primary health centers (PHC) across India were functioning without a doctor as on March 31, 2017. The shortfall of specialists was 81 per cent in community health centers (CHC). Together, CHCs and PHCs had a 22 per cent shortfall of pharmacists and a 40 per cent shortage of laboratory technicians.

It is easy to deride a program like Ayushman Bharat as a populist measure but we must look beyond to serve those several thousand of our fellow citizens who are in need of medical help but cannot afford. Let our imperfections be the inspiration to usher in a healthy and wealthy India by 2022.

Dr. Dharminder Nagar

MD, Paras Healthcare

Dr. Dharminder Nagar is the MD of Paras Healthcare.

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