Ayushman Bharat: a health scheme that should not fail

Ayushman Bharat: a health scheme that should not fail

Article:

1. Sujatha Rao, former Union Secretary, MHFW, presents her views on the implementation of Ayushman Bharat.

Important analysis:

2. Health policies have two objectives:
   • To enhance the health of the population and
   • Reduce the financial risk for those accessing treatment.
3. Success of health policies are measured by:
   • Reduction in the disease burden,
   • Subsequent increase in people’s longevity and
   • Reduction in cost of health-care.
4. Ayushman scheme has two components:
   • Upgrading the 150,000 sub-centres (for a 5,000 population level) into wellness clinics that provide 12 sets of services; and
   • Providing health security to 40% of India’s population requiring hospitalisation for up to an assured sum of Rs 5 lakh per year per family.
5. Problems in implementation:
   • Shortages in the supply of services (human resources, hospitals and diagnostic centres in the private/public sector),
   • There is no clarity on the negotiating/containing prices that is being charged for services. For example: The ‘Rajiv Aarogyasri’ scheme of Andhra Pradesh has only package rates, but package rates are not a substitute for arriving at actuarial rating.
   • There is absence of primary health care centers.
6. Provision of Portability under National Health Policy Scheme raises concerns as it will take time for hospitals to be established in deficit areas. This in turn could compel the patients to move toward the  southern States that have a comparatively better health infrastructure than the rest of India.
7. This led to increase pressure of insured patients from other States, growing medical tourism (foreign tourists/patients) as a policy being promoted by the government, and also domestic patients, both insured and uninsured on southern states.
8. The implementation of Ayushman Bharat will have to be contextualised and synchronised with a reform agenda that must include:
   • Improved governance and
   • Enforcement of regulations.
9. Success of Ayushman Bharat can help to achieve the goals of equity, efficiency and quality.