The Narendra Modi government rolled out its ambitious medical insurance scheme — Ayushman Bharat – recently. Launched just ahead of the 2019 parliamentary elections, it seeks to benefit the poorest of the poor in Bharat (the rural India) and the have-nots of urban India, writes Sandeep Datta of Elets News Network (ENN).
Reflecting its determination to take healthcare facilities to over 100 million families, the Centre’s flagship scheme is arguably world’s biggest health financing scheme. One can gauge its significance from the fact that it is aimed to cover 100 million families or, nearly 50 crore people!
During this year’s Independence Day speech, Prime Minister Narendra Modi had announced that while the scheme would initially cover 10 crore poor families as per the socio-economic census of 2011, it will in the coming days also benefit the lower middle-class, middle-class and upper-middle class in terms of jobs in the medical sector, as new hospitals will open in Tier-2 and Tier-3 cities.
On September 23, the Prime Minister launched Ayushman Bharat, the world’s largest government-funded healthcare scheme which has been renamed PM Jan Arogya Yojana (PMJAY). It was set to become operational two days later on the birth anniversary of Pandit Deendayal Upadhyay, the co-founder of the ruling BJP and an RSS ideologue.
The scheme was launched from Ranchi reportedly on the request of Jharkhand Chief Minister Raghubar Das. All National Democratic Alliance (NDA) chief ministers launched the scheme from their respective States as well on September 23.
A section of experts has lauded the Government for taking landmark step in healthcare ecosystem.
“These initiatives will transform the healthcare infrastructure of the State. The roll out of the Scheme was slated to be on September 25 as per August 15 announcement, however, implementing it two days prior to the set schedule and selection of state to kick it off manifest the confidence of the government and its agencies in the readiness of the scheme,” Daljit Singh, President, Healthcare Federation of India (NATHEALTH) said.
Anjan Bose, Secretary General, NATHEALTH, believes Jharkhand and several other States in the country desperately need adequate healthcare infrastructure and insurance coverage.
“It is very encouraging to note that Jharkhand’s 85 percent population will be covered under the PMJAY. Private providers and other stakeholders such as health insurers responded very positively to the scheme and the success should be ensured in terms of quality and affordability,” Bose said.
Arindam Haldar, CEO, SRL Diagnostics, says the landmark scheme ushers in a new era of prosperity wherein access to quality and affordable healthcare for all Indians is no longer a dream. However, he believes, the effective implementation, availability of adequate financial resources, management and monitoring will be the key drivers of success.
“The health of the people of a country is directly responsible for the growth and progress of that nation. Healthcare delivery in India is at a decisive juncture and now after the launch of Ayushman bharat, is uniquely poised to undergo a change at all its stages — prevention, diagnosis, and treatment,” Haldar said.
“I am hoping that Ayushman Bharat would successfully address the three fold challenge in healthcare – lack of infrastructure to treat chronic secondary and tertiary diseases, exorbitant treatment costs and high level of out-of-pocket expenses,” he further stated.
Anuj Gulati, MD and CEO, Religare Health Insurance, says, “‘Ayushman Bharat’ will bring in the much needed revolutionary change to healthcare in India. It will surely transform the entire healthcare ecosystem. A healthy nation is what will make our country prosperous.”
Zoya Brar, Founder & Managing Director, CORE Diagnostics, says, “First of all, the much-needed provisions and plans under the Ayushman Bharat scheme is in fact, CORE’s vision -to enhance the treatment process for critical and life burdening diseases. However, the need of the hour is put more weight on the equitable accessibility and availability of quality diagnostics since we are already dealing with complicated healthcare issues like incorrect, unnecessary, misleading or over diagnosis and treatment.”
“The scheme will not only increase the penetration of diagnostics but also encourage the citizens to make their health plans in conductions with retirement plans. It is a chance to foster innovation in a coordinated manner for private players to us devise low-cost new diagnostics solutions and customize the existing ones for the greater good of deprived section of the society,” she said.
“We anticipate an organized liaison between government and private healthcare providers to serve the unmet and neglected needs of quality and accessibility in diagnostics space but also build up SOPs and KPIs for hospitals and pathologists. We are already working with Punjab government on a Hepatitis C eradication programme through preemptive screening. We do foresee the need to scale our capabilities to serve the masses. Notwithstanding, it is imperative to the right strategy for the pricing and identify the vulnerable for the scheme to make the maximum impact in the future,” Brar stated.
Understanding Ayushman Bharat — Key Points
- An annual cover of Rs 5 Lakhs per family for secondary and tertiary care
- No money required to be paid by family for treatment in case of hospitalisation
- Avail free treatment by visiting public or empanelled private hospitals across the country
- Carry any prescribed ID to receive treatment at the hospital
- All pre-existing conditions are covered from day one of the policy
. The benefit cover will include pre & post hospitalisation
- No restriction on family size, age or gender
- All members of eligible families as present in SECC database are automatically covered
- The beneficiaries can avail benefits in both public and empanelled private facilities.
- The scheme’s benefits are portable across the country. A beneficiary covered under the scheme will be allowed to take cashless benefits from any public/private empanelled hospitals across the country.
Ayushman Bharat – National Health Protection Mission will have major impact on reduction of Out of Pocket (OOP) expenditure on ground of:
Increased benefit cover to nearly 40% of the population, (the poorest & the vulnerable)
Covering almost all secondary and many tertiary hospitalisations (except a negative list)
The State Exchequer’s Role
Ayushman Bharat may cost the exchequer around Rs 5,000 crore this year because of the time taken to rollout the scheme. The scheme will cost Rs 10,000 crore when it is rolled out across India next year. While this year there are likely to be 8 crore beneficiaries, the target is to cover 10 crore by FY 20. The expenditure incurred in premium payment will be shared between Central and State Governments in specified ratio as per Ministry of Finance guidelines in vogue.
The Flip Side
A section of the society opines Ayushman Bharat is very much required for people living in villages, towns, cities and States across India but not that much in South India. It is so because various healthcare schemes have been already existing and benefitting people in the South for a long time.
While appreciating the scheme, a section of the society looks at it with questioning eyes in terms of implementation challenges, that are to determine its success or failure.
Another section of society feels the Government must think of providing coverage for crop insurance and medical coverage reciprocal to land holding by increasing the annual land rent which will take care of farmers’ maladies.
Some others stress upon the absence of medicare scheme for the elderly retired people, as they simply cannot afford any costly medical insurance scheme as it is present with the insurance companies.
Conclusively saying, away from various political opponents and cynics’ capacity to foresee the brighter side of Ayushman Bharat, one cannot deny that this endeavour has raised a new hope of a real change.
No matter what but the Modi Government looks well-intended at least in taking healthcare to the most marginalised and the vulnerable people of the country awaiting it on the last-mile. At least it has given birth to a hope of change with Ayushman Bharat.