Monday, June 21, 2021

Ayushman Bharat

Touted as one of the biggest health schemes in the world, Ayushman Bharat rolled out by the BJP-government some weeks back, faces the challenge of higher budgetary allocation and implementation of the campaign to cover a large population for health and medical cover. The scheme aimed at providing guaranteed access to treatment free of cost at the point of delivery to about 40 percent of the population selected on the basis of census conducted on socio-economic conditions of the citizens. This appears to be the first step on the long road to universal health coverage, although it has been launched by the centre quite late in its term, possibly with an eye on the next year’s general elections. The previous experience of the government on National Rural Health Mission launched by the UPA-II government to reach the door-steps of citizens in every part of the country should act as a guiding factor and course correction for its implementation. The new scheme appears to be a thread from the previous NRHM project which faced problems of budgetary shortfall right from its inception and could not reach the targeted population in rural and far flung areas. It faced the problems of shortage of funds, lack of trained manpower and non-existence of infrastructural facilities in the hinterland. Similar challenges will be the faced by the Ayushman Bharat scheme also in the years to come. Since the centre has announced that 10.74 crore families identified through Socio-Economic Caste Census data will be given an annual Rs 5 lakh cover under the Pradhan Mantri Jan Arogya Yojana (the insurance component of the scheme), the question of eligibility appears settled. But the late start makes it virtually impossible for all those who are technically insured to avail of the services that state agencies must make available, within a reasonable time-frame. The citizens, who are already insured after payment to the insurance companies, will be the bigger lot that will be left out from this scheme for no fault of theirs. Moreover, it is also to be seen how the insurance company chosen by the centre will be dealing with the cases for providing medical cover to the clients. The question that majority of the private companies earn their profits from denying the claims to the people will have to be answered by the government. And, the allocation of just Rs 2,000 crore during the current financial year to the PMJAY cannot provide the promised cover to the large population targeted to be included. Not all states and Union Territories are in a position to raise their own share, and a few have not even joined the scheme. The challenge of funding, therefore, remains there on the ground. And without adequate budgetary commitments, the implications of pooling the financial risk for such a large segment of the population through insurers or state-run trusts or societies make the outcomes uncertain. The insurance cover for such schemes is minimal keeping in view the interests of the private companies involved in it. For guaranteeing health-care access using private or public facilities presumes strict cost control on treatment. In the case of the PMJAY, this is to be achieved using defined treatment packages for which rates are already prescribed by the government agencies. Costs are a contested area between the care-providers and the centre, and many for-profit hospitals see the government’s proposals as unviable. In the absence of proper preparation, the Ayushman Bharat administrators are talking of a rate review. More importantly, a lot of time has been lost in the NDA government’s tenure, when state governments should have been persuaded to regulate the hospital sector under the Clinical Establishments (Registration and Regulation) Act, which is close ten years old. The regulation provides for fixing standards of facilities and specified rates for procedures. Apprehensions of fraud have prompted Ayushman Bharat administrators to announce that some key treatments should be availed through public sector institutions. But public facilities are not up to mark. It is important to reduce the pressure on secondary and tertiary hospitals for expensive treatments by investing in preventive and primary care facilities. In this case, over 1.50 lakh health centres of the National Health Protection Mission can play an important role. The priority should be to draw up a comprehensive plan for universal health coverage, through continued upgradation of the infrastructure in public sector to make this scheme workable.