[Answered] Give a critical evaluation of ayushman bharat. How it can do wonders if implemented effectively?

In 2011-12, more than 55 million Indians were pushed into poverty because of rising expenditure on healthcare. Government of India sue to rising healthcare challenges launched Ayushman Bharat: National Health Protection Scheme (AB-NHPS) which has a defined benefit cover of ₹ 5 lakh per family per year covering over 10 crore families. Pegged to be world’s largest healthcare scheme it has some issues and challenges.

Various issues and challenges

1. A state subject- Under the 7th schedule of the Indian Constitution, health is a state subject. Apart from central institutions such as the All India Institute of Medical Sciences, a major chunk of the hospitals/ medical centres is state-owned and -operated. A nationwide scheme of health insurance to supply healthcare facilities at the state level leads to a dilution of the state responsibility in the provisioning of the same. Further it require centre state on equal footing.
2. Not a long term solution– Conferring responsibility on private insurance could not be long term solution. As public private partnerships in past have been criticised for various issues, above can also lead to issues in the implementation of Ayushman Bharat. Further in rural areas private doctors are few as doctors are reluctant to work in rural areas. Mostly quacks or family doctor serve, so it can be an issue.
3. Infrastructure– Shortages in services such as infrastructure, Human Resources, quality of doctors etc have always been an issue. Many villages still lack roads, nearby hospitals, proper staff etc. Thus implementation of the scheme would be a huge task.
4. Monetary- It requires huge amount of funding and spending. States have to mobilise funds which will not be an easy task being many states are under debt, further borrowing may put balance sheet under stress. Further there is no uniform pricing system for other health interventions like medicines and diagnostics.
5. Not Universal- Developed nation has universal health coverage, while scheme doesn’t cover all sections of society, so many may remain excluded. It cover only 40% of Indian population.

How it can do wonders?

1. Better Reach- Establishment of Ayushman Bharat National Health Protection Mission Agency at National Level and State Health Agency will ensure implementation of Scheme in a targeted manner ensuring effective implementation. The States and UTs can implement scheme through various means like insurance company or Directly through Trust/Society. This would increase ambit of the Scheme at Ground levels.
2. Creation of healthcare Infrastructure– A strong Network of  the 1,50,000 Health and Wellness Centres being developed will strengthen the national focus on preventive healthcare.
3. Targeted coverage- It will Cover more than 10 Crore Poor and Vulnerable Families of the Society.
4. Penetration and increased access- Participation of private sector will not only ensure more doctors but also near home availability of health facilities. It will increase the availability near Home in Rural Areas through trained professionals. It will also increase access to Vulnerable Sections of the Society to Healthcare. Further The scheme is portable in nature thus will also benefit the migrated population in unorganised sector which are often excluded in government schemes.     
5. Affordability- Another impact of the PMJAY will be rationalisation of the cost of care in the private sector.
6. Employment- It will generate Employment and  will create lakhs of jobs for professionals and non-professionals — especially women. It will give a boost to the health technology industry.
7. Better Healthcare System- It will be an enabler of quality, affordability and accountability in the health system. The empanelled hospitals have been tasked to follow the treatment guidelines. Patient outcomes will be monitored.

Government data suggests that about 63% of the people have to pay for their own healthcare and hospitalisation expenses as they aren’t covered under any health protection scheme. Hence, the Ayushman Bharat scheme is well-intentioned. However, its implementation in the current form need extra efforts and can solve nation’s health issues, which require state-centre efforts and intent.