Achieve Ayushman Bharat

Source: The Hitavada      Date: 07 Feb 2018 09:12:13

By JYOTSHNA PANDIT,

 

Ayushman Bharat promises a country where no citizen will be sucked into poverty due to a high out of pocket (OOP) expenditure on health.
Despite substantial investment in health systems under the National Health Mission, public health facilities have been unable to meet healthcare needs of the people.
As a result, an emergency health issue compels the poor to take shelter in private facilities, which are way beyond their means.

UNION Finance Minister Arun Jaitley, in his Budget speech 2018-19, made an effort to unveil an important dimension of New India, Ayushman Bharat. This promises a country where no citizen will be sucked into poverty due to a high out of pocket (OOP) expenditure on health. Despite substantial investment in health systems under the National Health Mission, public health facilities have been unable to meet healthcare needs of the people. Access, availability of infrastructure and manpower, and quality of care are some of the reasons behind their failure. As a result, an emergency health issue compels the poor to take shelter in private facilities, which are way beyond their financial means. OOP expenditure on health in India is a whopping 63 per cent of total health expenditure. This is more than thrice the global average of 20.5 per cent. It’s one of the prominent reasons for impoverishment among the masses. Unplanned expenditure on health puts severe stress on limited finances available with the poor families, forcing them to sell off their assets to receive treatment and thus pushing lakhs of households below the poverty line every year.


Ayushman Bharat aims at tackling both the causes behind high OOP expenditure on health which are for the outpatient as well as hospitalisation charges. Its success would be a boon to crores of poor households in the country. It proposes setting up of 1,50,000 health and wellness centres across the country. These centres would provide comprehensive healthcare, maternal and child care, disease screening, free drugs and diagnostics to the poor. When established and fully operational, they are likely to reduce expenditure on outpatient care, which forms a higher percentage of OOP spending.


Another flagship scheme under Ayushman Bharat is the National Health Protection Scheme (NHPS). It aims to provide a health insurance cover of up to Rs. 5,00,000 annually to 10 crore families. It has thus been proposed to cover 40 per cent of the country’s population for in-patient care in secondary and tertiary hospitals. The announcement of NHPS in the latest budget has received an overwhelming response, with the insurance cover under the scheme now increased five fold - from Rs. 1,00,000 to Rs. 5,00,000 annually per family. If implemented properly, NHPS will be a big leap towards providing Universal Health Coverage (UHC). It will facilitate huge private investment in the health sector at district and sub-divisional levels too.

A boost to the job creation in health sector is also expected. Announcement of the new national flagship programme, Ayushman Bharat, is definitely a bold move of the Centre. However, the devil lies in the detail. The biggest challenge would be to quickly work out the contours of the scheme and the implementation model. A frail predecessor of NHPS is the Rashtriya Swasthya Bima Yojana (RSBY). However, it has suffered a poor uptake due to its paltry coverage and was also plagued with problems of transparency and efficiency. But learnings from implementation of RSBY and many similar State Government schemes would be vital to avoid pitfalls experienced in the past.


An important question is why put a ceiling on the number of people to be covered? Why not make it universal, welcoming every citizen to join? The Government can shell out the premium for the targeted 10 crore poor households while others can pay the premium themselves. This will provide benefit of a large risk pool to everyone and drive down the premium amount and cost of various health packages substantially.

Rolling out the scheme across the country in partnership with State Governments will pose a challenge in implementation. Stark differences in the viewpoints is natural and building a consensus would be time consuming. Given a limited bandwidth in the Central Ministry of Health and Family Welfare, it is important that it should be implemented by an expert, empowered, multi-stakeholder, autonomous body.


Challenges in implementing the scheme are numerous but not insurmountable. Leakages of funds, duplication of beneficiaries, needs of the migrant population, non-availability of quality health facilities, lack of integrated information technology-based systems are some of them. It may be a good idea to have public health facilities also on the panel for providing health services for a healthy competition. This will also lead to improvement in Government run facilities. Another suggestion for implementing it is to have a completely cashless, Aadhaar-based, system, having nation-wide portability, riding on robust information technology platform.

A pan country integrated system will also provide extremely valuable data for health research and disease surveillance. A comprehensive electronic health record including the investigation reports would also become a reality. While Ayushman Bharat has been termed a game changer, and rightly so, financial allocation and clarity on contours of the scheme needs to be understood. However, the new flagship scheme of the Government is definitely a strong pronouncement of the central leadership’s strong commitment to the health of India’s poor.