Ayushman Bharat Scheme Cheers Private Players

Ayushman BharatThe launch of Ayushman Bharat by Prime Minister Narendra Modi, the Government of India’s ambitious healthcare plan for 100 million poor and vulnerable families, has underlined tremendous scope that public-private partnership in health sector holds in future, observes Priya Yadav of Elets News Network (ENN).

While most state governments are pulling out all stops to provide health cover to the employees, it is the private health sector that is gearing up to spruce up its service delivery to reap benefits of the windfall.

The Ayushman Bharat scheme has two-fold mission — one, to create a network of health and wellness centres to deliver comprehensive primary healthcare close to the community, and two, to provide insurance cover to 40 percent of country’s population, that is most deprived, for secondary and tertiary care, including for instance, hospitalisation costs.

It aims at covering 10 crore poor and vulnerable families and provide a cover of Rs 5 lakh per family per year for secondary and tertiary care hospitalisation.

Survey done by NITI Aayog on the data thrown up by Rashtriya Swasthya Bima Yojna has shown that private hospitals are preferred by beneficiaries, both of RSBY and state level health insurance schemes.

In Haryana, 67% of beneficiaries under RSBY went to private clinics and hospitals as against 87% in Uttar Pradesh and 73% in Gujarat. States like Rajasthan, Bihar and Madhya Pradesh saw 100% of claims coming from private health sector.

Aware of the gap between the demand for health services and the infrastructure available in the government sector, private health facilities are gearing up big time to move in and fill in the gap. This has spelt a win-win situation for all – while people queuing up at hospitals are getting good treatment, private hospitals are getting a constant flow of customers and the government is effectively discharging duty by chipping in with the health insurance.

In northern India, most of the State governments are acutely aware of the need of the hour and have taken steps. Over two years ago, the Punjab Cabinet gave green signal to implement cashless health insurance scheme in place of reimbursement of medical expenses.

The facility is provided to government employees and state pensioners and their dependants, over 6.5 lakh in number, in more than 250 empanelled public and private hospitals in Punjab, Chandigarh and NCR ( Delhi, Gurgaon and Noida).

Expenses of the treatment taken outside the state would be reimbursed within 15 days by the insurance company. A patient admitted to the hospital for treatment will not have to pay any money as also 246 kinds of outdoor procedures and the treatment of chronic diseases in out patient department would be free of cost.

Additionally, the prehospitalisation benefits up to 7 days and post hospitalisation benefits up to 30 days will be covered under the insurance scheme. Two years down the line, the government is mulling better options. A new universal health insurance scheme, covering all residents, is on the anvil. The State government is now working towards strengthening its own health infrastructure and empanel the government run hospitals for treating insurance covered patients.

“ The need of the hour is to strengthen the government hospitals and improve service delivery. We want to provide quality health services to all that is also cost effective,” says Brahm Mohindra, Health Minister, Punjab.

The State government is grappling with a situation where insurance companies have backed out following staggering bills slapped by private hospitals.

In neighbouring Haryana, the State government is working towards implementing an insurance scheme wherein if a patient visits any private doctor, his fee would be reimbursed by the state government.

As of now, the treatment is free of cost in government hospitals. There is a growing pressure on doctors in the government hospitals and the move is expected to ease it.