Social Justice

Ayushman Bharat, a flagship scheme of the Government of India, was launched as recommended by the National Health Policy 2017, to achieve the vision of Universal Health Coverage (UHC). This initiative has been designed to meet Sustainable Development Goals (SDGs) and its underlying commitment, which is to “leave no one behind.”

Features Of Ayushman Bharat

Ayushman Bharat adopts a continuum of care approach, comprising of two interrelated components, which are

1. Health and Wellness Centres (HWCs) : 1,50,000 Health and Wellness Centres (HWCs) by transforming the existing sub-centres and Primary Health Centres. These centres are to deliver Comprehensive Primary Health Care (CPHC) bringing healthcare closer to the homes of people. They cover both, maternal and child health services and non-communicable diseases, including free essential drugs and diagnostic services. 2.
2. Pradhan Mantri Jan Arogya Yojana (PM-JAY): This is the largest health assurance scheme in the world which aims at providing a health cover of Rs. 5 lakhs per family per year for secondary and tertiary care hospitalization to over 10.74 crores poor and vulnerable families (approximately 50 crore beneficiaries) that form the bottom 40% of the Indian population. PMJAY is fully funded by the Government and the cost of implementation is shared between the Central and State Governments.
3. National Health Authority (NHA) : The apex body responsible for implementing the scheme at the national level. To implement the scheme at the State level, State Health Agencies (SHAs) in the form of a society/trust have been set up by respective States. SHAs have full operational autonomy over the implementation of the scheme in the State including extending the coverage to non-SECC beneficiaries.

Critical Evaluation

1. Underspending: As per Govt., more than 10 crore e-cards (for health insurance) were issued, and Rs 7,490 crore worth of treatments pre-authorized in just 365 days. But this amounts to just over Rs 16,000 per person: much lower than the Rs 5 lakh limit per family under this program.
2. The shift of burden: The health insurance scheme is helping millions reduce their expenditure on health. But the burden has not been lifted. Instead, it has shifted to the Indian government’s shoulders, which is already facing challenges in meeting the needs of the population.
3. Not hitting the root of the problem: Govt. is spending only 1.15% of the gross domestic product or GDP (with plans to increase this to 2.5% of GDP by 2025) on health and most of it is for curative services as compared to preventive services.
4. Increased burden on private hospitals: Despite the HWCs including non-communicable diseases in comprehensive care, the loopholes in the basic infrastructure and services in HWCs have remained almost the same. This will increase the burden on public hospitals and super-speciality clinics and also force the poor to opt for private services, which after a point, aren’t affordable for them.
5. States participation and underpricing issues: The rates set for different procedures under Ayushman Bharat are low. This might eventually reduce the quality of services provided or even make them unviable for hospitals. Looking at this scenario, states such as Odisha, Delhi, Telangana, Kerala, and Punjab have opted out of the program.
6. Fraudulent cases: A program this large has much room for fraud. India’s poor artificial intelligence or AI-based monitoring has encouraged fraud from families who forge papers of adoption or relationship with the beneficiaries.
7. Exclusion: Ayushman Bharat does not at this time cover the middle-income section of society. Huge or unexpected medical expenditures can push these families below the poverty line.
8. Transparency issues: Even after a year, the cost revisions in PM-JAY for package procedures, for example, an angioplasty, or a knee replacement have not been made public
9. Out of pocket expenditures: Patients still have to spend a lot from their pocket. In many cases, they have to get diagnostic services, drugs, and implants from outside as they are often not available in the hospitals.

Way Ahead

1. Innovate ways to reduce the cost of diagnosis and diagnostics.
2. To have a ‘technological solution’ to measure and track the quality of healthcare.
3. Maximizing beneficiary awareness.
4. Enhance the quality and security of data.
5. Reduce infection rates at hospitals.
6. Build and maximize the capacities of the health workforce.
7. Develop robust and real-time fraud detection systems.

Ayushman Bharat has put India on an irreversible path towards universal healthcare. The scheme will keep evolving, taking into account the experience of evidence generated from its implementation. Prime Minister Narendra Modi said the first year of the scheme has been one of Sankalp (action), samarpan (devotion), and seekh (learning). Given the highest level of political support for these reforms, failure is not an option.