Be Mains Ready

Approach

• Write about the status of healthcare sector in India and the need for effective insurance based model.
• Briefly explain the aims, objectives and advantages of Ayushman Bharat.
• Compare it with other insurance schemes.
• Mention the challenges faced in rolling out such a scheme.
• Conclude by writing the relevance of such a scheme and its impact on lives of people.

Introduction

Health insurance penetration in India is dismally low, covering only about 29% of households surveyed under the NFHS-4. One of the aims of National Health Policy 2017 is to achieve universal access to good quality health care services without anyone having to face financial hardship as a consequence. Hence, Ayushman Bharat scheme is a much needed step in the right direction.

Body

Following are the components and objectives of Ayushman Bharat Mission:

• Health and wellness centers: Under this, 1.5 lakh centers will provide comprehensive health care, for non-communicable diseases and maternal and child health services. These centers will also provide free essential drugs and diagnostic services.
• National Health Protection Scheme (PM Jan Arogya Yojana): Scheme to provide insurance based coverage to poor and most vulnerable sections of society.

It will subsume the on-going centrally sponsored schemes – Rashtriya Swasthya Bima Yojana (RSBY) and the Senior Citizen Health Insurance Scheme (SCHIS). However, there are certain improvements over its predecessors:

• Enhanced reach and coverage: It benefits 10 crore families (40% of the population), going much beyond a total of 3.6 crore families under RSBY. Also, coverage under RSBY was Rs.30,000 annually for healthcare. Under NHPS, it is upto Rs.5 lakhs per family per year for secondary and tertiary care hospitalization.
• Private hospital’s participation: Private hospitals can also empanel themselves to the scheme. Pre-determined packages for treatment have been provided.
  
  • Cost of surgeries like C-section and knee replacement will be fixed which will get reimbursed to the hospital by the government.
• Priority is being given to strengthening primary healthcare. 70% of allocated funds are being spent on upgrading health and wellness centers to provide comprehensive accessible healthcare.
• Simple product design which is easy to administer. It is an entitlement based scheme where beneficiaries are enrolled automatically based on deprivation criteria in the SECC database. There is no cap on family size and age of the beneficiaries.
• Scheme is entirely cashless and nationally portable. Hence, it will have a major impact on the most vulnerable migrant population.

However, certain challenges remain in the implementation of such a scheme which covers almost 40% of the country’s population.

Challenges

• Financial constraints: Overall budget outlay for the scheme was Rs 2000 crore for 2018-19 which questions its feasibility. There needs to be a balance between the interests of the patient, the insurer and the hospital as well for the model to sustain. Hence, the prices of packages need to be rationalized accordingly.
• Though it improved access to health care, it may not reduce out-of-pocket expenditure (OOPE) or health payment-induced poverty.
• Infrastructural issues: Hospital infrastructure, which includes beds and emergency care services, still remain defunct in most of the cities.
• Human resource management: Equipping the centers with trained health personnel and retaining talented human resources in rural and remote areas still needs to be done.
• Prevention of unethical medical practices and frauds while availing insurance facility still persist.

Past experience of RSBY shows that India lacks the institutional expertise and capacity to implement public health insurance schemes effectively at such a scale.

Conclusion

Ayushman Bharat is the largest government-funded healthcare scheme in the world. Even though there are challenges in the implementation of the scheme at such a large scale, yet it has a potential to change the lives of millions if properly implemented.