Ayushman Bharat : Analysis

Context:

  • Universal health coverage is getting prioritised as a part of political reform with the launch of two pillars.

 

Current state of Healthcare:

  • Poor condition of healthcare in country; Lack of infrastructure;
  • Poor health services in government hospitals; Private hospitals out of reach of most people.
  • According to the Global Burden of Disease study, India is ranked low in the Healthcare index; India stands at a rank of 154.
  • But despite this, the budget allotment on healthcare services is extremely low. India spends less than 2% of her GDP on public healthcare.

 

Ayushman Bharat:

  • The National Health Protection Mission or Ayushman Bharat Yojana, launched by the Government is the first major step.
  • Ayushman Bharat Yojana is a program which aims to create a healthy, capable and content new India.
  • It will also focus on the poor and weaker sections of the society.
  • It aims to provide insurance of up to 5 lakh rupees to each family.
  • The new scheme also intends to improve secondary and tertiary healthcare services for crores of Indians.

 

There are two flagship initiatives under Ayushman Bharat:

  1. Pradhan Mantri Jan Arogya Yojana (PMJAY):
    • Under this scheme, 1.5 lakh health sub-centres are being converted into health and wellness centres.  
    • It will bring the healthcare system closer to the people.
    • The centres will provide comprehensive healthcare, including treatment for non-communicable diseases and maternal and child health services.
    • Besides this, they will also provide free essential drugs and diagnostic services;
    • Rs. 1200 crore have been allocated for this flagship programme. 
    • The scheme will cover more than 10 crore poor families, which is approximately 50 crore persons.
    • It will also setup wellness centres which will give poor people OPD facility near their homes. 
  2. National Health Protection Scheme:
    • The National Health Protection Scheme will cover over 10 crore poor and vulnerable families.
    • It will provide coverage up to 5 lakh rupees per family, per year for secondary and tertiary care hospitalization.

 

Best health care at the lowest possible cost should be:

  1. Inclusive
  2. make health-care providers accountable for cost and quality
  3. achieve a reduction in disease burden, and
  4. eliminate catastrophic health expenditures for the consumer.

 

Criticism of Ayushman Bharat:

  • Currently, the NHPM is pushing for hospitalisation at secondary,  and at tertiary-level private hospitals, while disregarding the need for eligible households to first access primary care, prior to becoming ‘a case for acute care’.
  • It is important to note that without the stepping stone of primary health care, direct hospitalisation is a high-cost solution.

 

Problem of constraints:

  • Public sector health capacities are constrained at all levels.
  • Further, forward movement is feasible only through partnerships and coalitions with private sector providers.
  • It is important to note that these partnerships are credible only if made accountable.
  • It has been suggested that Health-care providers (public/private) should be accredited without any upper limit on the number of service providers in a given district.

 

Need of a holistic approach:

It is believed that one must bring together all relevant inter-sectoral action, linking health and development, so as to universalise the availability of:

  1. clean drinking water,
  2. sanitation,
  3. garbage disposal,
  4. waste management,
  5. food security,
  6. nutrition and
  7. vector control.

Further, the Swachh Bharat programme must be incorporated in the PMJAY.  These steps put together will reduce the disease burden.

 

Way Forward

  • A public education media campaign could highlight the merits of personal hygiene and healthy living.
  • The States of Kerala and Tamil Nadu have demonstrated that high-performing, primary health-care systems do address a majority of community/individual health needs.
  • The health and wellness clinics must connect with early detection and treatment.
  • It is believed that robust delivery of preventive, clinical and diagnostic health-care services will result in early detection of cancers, diabetes and chronic conditions, mostly needing long-term treatment and home care.
  • This would further minimise the demand for hospitalisation.
  • In conclusion, investment in primary care would very quickly reduce the overall cost of health care for the state and for the consumer. Technology and innovation are further reducing costs. AI-powered mobile applications will soon provide high-quality, low-cost, patient-centric, smart wellness solutions. Currently, the scaleable and inter-operable IT platform being readied for the Ayushman Bharat is encouraging.