With a population of 1.3 billion across urban and rural areas, India’s healthcare ecosystem is unique. The healthcare ecosystem is one of the largest sectors both in terms of revenue and employment. As per an IBEF (India Brand Equity Foundation) report, the healthcare sector in India is expected to grow from $160 billion in 2017 to $372 billion in 2022. In this context, the Ayushman Bharat mission is a welcome move and a great opportunity to address the country’s unique health challenges.
The Ayushman Bharat scheme that seeks to provide health insurance cover of Rs five lakh per family per year to those belonging to poor and vulnerable populations, is likely to benefit 10 crore Indian families. To ensure that nobody is left out (especially women, children and elderly), the scheme does not plan to have a cap on family size and age, which is seen as a comprehensive measure. The scheme is expected to cover around 40 percent of the population and it has been proposed as a fully government-funded scheme, in which the cost will be shared by both, the Central Government and the State Governments in the ratio of 60:40.
With the Government building a strong IT framework to prevent fraud and misuse, we look forward to the successful implementation of the scheme. Earlier this year, government’s policy think tank NITI Aayog sought the World Bank’s assistance on providing necessary information and expertise on fraud detection and prevention. With an allocation of around Rs 10,000 crore for the project, the volume of insurance claims will see an unprecedented growth. Subsequently, instances of insurance fraud are expected to increase. This increased risk of Fraud, Waste and Abuse (FWA), can be mitigated by leveraging innovation, technology, data and analytics to arrive at various fraud indicators, and predictive modelling can be applied to identify fraudulent customers, agents, employees, hospitals, doctors etc.
The Government has shown interest in Public Private Partnerships (PPPs) at all levels, based on utilisation, viability gap funding and subsidisation for below poverty line (BPL) population. Some State Governments have shown keenness to outsource non-clinical services in all major Government hospitals. Overall, such actions by the State Governments can result in attracting private players to invest and participate in Ayushman Bharat scheme.
The health and wellness centers, a part of the Ayushman Bharat scheme, also provide a plethora of opportunities for private players. For instance, effective implementation of Information Technology (IT) can play a significant role in making healthcare both inclusive and accessible to rural India. Such centers will be a great boon for a country like India as it promises to offer several benefits such as live video consultation with specialized doctors along with real-time transmission of patient health records and diagnostic reports.
The proposed centers are supposed to be the main points of contact between communities and the public health system. Each center will have at least three full time health workers accompanied by five community health workers, all of whom will be preferably recruited locally.
The centers will provide primary, out-patient care and referral access to secondary and tertiary healthcare when needed. The Government has so far announced plans to open around 1.5 lakh wellness centers across the country.
Given the demographics of the country, the responsibility of building a healthier India cannot be alone entrusted on the Government. The private sector has over the years made a significant contribution to the quality of healthcare and it has emerged as a pivotal supplier of healthcare services. We strongly believe schemes like the Ayushman Bharat, if implemented well, along with the support of private players will go a long way in making India a healthy and wealthy nation.
(Disclaimer: Writers are Dr Abhishek Nirwal, Healthcare SME, Optum and Saurabh Garg, Enterprise Architect, Optum. Views expressed are a personal opinion.)