One of the key goals of achieving Universal Health Coverage is financial protection i.e., affordable health services at low costs for every individual particularly funded through public sources, as recommended by the World Health Organisation (WHO). This leads to equity in financial contribution and distribution of risk amongst both healthy and sick in society.
As per National Health Account 2015-16, it is estimated that out of pocket expenditures (OOPE) comprise over 60% of the total health expenditures in India leading to catastrophic payments and crippling poverty for families seeking hospitalisation. Due to this every year, over 60 million Indians fall below the poverty line. Lack of access to good quality tertiary care services has directly affected the sick, elderly and women in families preventing them from seeking timely care. It has forced people to either avoid treatment for years or further aggravated chronic conditions.
It can be argued that the effectiveness of the Ayushman Bharat programme depends on overcoming many other challenges besides an increase in budget allocation.
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Good health policies of the country make a significant impact on its economy through building the good health status of the population. The latest Economic survey states that India ranks 179 out of 189 countries in prioritization accorded to healthcare in its government budget. Indian Government is committed to increasing public spending from the current 1.35 % to 2.5 % of GDP shortly. Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (PM-JAY) is one such initiative to achieve this goal. It is expected to be a game-changer in India. As Prime MinisterNarendra Modi mentions “It is a holistic solution for a healthy India”. It strives to give free access to medical services to nearly 40 percent of the population which covers around 50 crores people along with free primary, secondary and tertiary level medical care by providing health insurance of Rs 5 lakh per family per year. The current budget has a higher allocation for Ayushman Bharat Digital Mission through building a national digital health ecosystem.
The latest figures on Ayushman Bharat portal show that 17.35 crores of people to date received Ayushman Bharat cards and 2.61 crores of persons availed the facility of hospital admissions. It is only a humble start. We need to see how effectively we can reach the vulnerable population to make it more effective. It can be argued that the effectiveness of the Ayushman Bharat program depends on overcoming many other challenges besides an increase in budget allocation. One needs to see how the interests of different stakeholders are synergized together. Let’s look into some of them. Central and state governments are some of the key stakeholders. It is important to notice that though Ayushman Bharat is rolled out by the central government, its implementation responsibility lies with the state governments. Many state governments such as Karnataka, Andhra Pradesh, Maharashtra, etc. have already launched their flagship health programs. The states can either join this program by subsuming their existing plans or running their health programs. Many state governments are still skeptical about joining hands with the central governments due to fear of losing autonomy.
The role of public healthcare in providing primary healthcare is very crucial for creating the nexus between primary and secondary healthcare. Inadequate availability of public healthcare infrastructure in terms of several primary healthcare centers, sub-centers, and other infrastructure has been a chronic problem in our country since independence. Though the program has an ambitious plan to build 1,50,000 Health and Wellness Centres (HWCs) by transforming the existing centers, it is difficult to implement it on the ground. It means the success of the program depends on the voluntary participation of the private healthcare sector, especially private hospitals. The program may benefit the private hospitals in boosting the demand for many special or super-specialized treatments and scaling up their operations. Approximately 23,000 private hospitals have been impaneled in this scheme. They are facing many challenges such as low fixed rates per surgery, the prevalence of fraudulent cases, and complicated reimbursement processes. The private health insurance sector acts as a major pillar of the program. The state governments ask for competitive bidding from the insurance companies for the accessibility of health insurance to the masses. This might help insurance companies to scale up very fast and reduce their average cost of customer acquisition. At the same time, they may run a high risk of reducing the premium charges to a low level where they may become unviable.
It is expected that firms operating in pharmaceuticals, diagnostics medical devices, and digital healthcare will act as a support system to the entire health eco-system. MedTech companies using technologies such as virtual reality, artificial intelligence, wireless sensors, 3D printing, digital healthcare can be used to collate and analyze data, bring down the costs and reach the bottom of the pyramid section effectively.
In a nutshell, we can say that the success of this program depends on the development of skilled manpower. Healthcare workers require additional skills such as empathy, trustworthiness, and communication skills along with technical and managerial skills. They are hard to develop in the short run. India needs to have good quality healthcare education institutes to create such skillsets. Successful implementation of this program will not only take India ahead on the global front in improving the health status but also in creating a strong base for future economic growth. The key to successful implementation depends on i) creating a mechanism to see that all the stakeholders are benefitting, ii) bringing coordination between different stakeholders, and iii) creating via gilant monitoring system to control the quality.
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