Ayushman Bharat- National Health Protection Mission (AB-NHPM)

Healthcare in India

• Healthcare in India is largely underpenetrated, with government expenditure at around 25% of the GDP and an underperforming public healthcare ecosystem.
• Problem of 3A’s– refer to the figure
• Dual disease burden: Even as the incidence of lifestyle diseases is steadily on the rise, a vast majority of rural and poor patients still suffer from infectious and acute diseases.
• Low levels of healthcare spend: India’s per capita public expenditure on health increased from Rs 621 in 2009-10 to Rs 1112 (around $16 at current exchange rate) in 2015-16.
• However, it is still ‘nominal’ compared to other countries. Switzerland spends $6944 on health per capita, whereas the US spends $4802 and UK spends $3500.
• Out of pocket expenditure pushing people into poverty– It is extremely worrying that nearly 55–60 million Indians are pushed into poverty every year because they are unfortunately compelled to shell out half of their annual household expenditure to meet medical needs, specially for hospitalisation.
• Shortages in government run insurance schemes- A majority of insured population is covered under Employees’ State Insurance Scheme or government sponsored schemes but these schemes have significant coverage limitations.

In order to address the shortages in healthcare system in India –one of the major policy initiatives of the government has been the announcement of the Ayushman Bharat – National Health Protection Mission (AB-NHPM) for the vulnerable section of the Indian population which, if implemented effectively, will help the nation move closer to the Sustainable Development Goal of ‘Universal Health Coverage’. It is expected that the scheme will have a far-reaching impact on the entire Indian healthcare and insurance landscape.

Ayushman Bharat – National Health Protection Mission (AB-NHPM)

Policy shortcomings:-

Systemic challenges that needs to be addressed:-

• Right pricing strategy- Difference between market price and NHPM price is high for costly procedures, thereby limiting the availability of these procedures. It is imperative to follow right pricing strategy on scientific basis for the scheme to make maximum impact.
• Right infrastructure strategy required to meet new bed capacity demand from AB-NHPM.
• Policy is reactive than proactive- The policy is reactive in nature rather than proactive. Policy lack focus on preventive care.
• Health is a state subject– Thus, taking all states on board will not be easy as many states prefer their own state insurance schemes over AB-NHPM.
• Providing rural masses with healthcare facilities as available in urban India is still a distant dream.
• Coverage extensive not exhaustive- Although the coverage is extensive under AB-NHPM but it is not exhaustive. Middle class is out of the ambit of the scheme.
• Foreseeable fraud challenges in NHPS
  • Enrolment of genuine/ghost beneficiaries
  • Impersonation in connivance with cardholders and hospital, leading to fraudulent admissions
  • Conversion of OPD patient into an IPD patient
  • Showing medical management cases as day care procedures
  • Deliberate blocking of higher priced package or multiple packages to claim higher amounts
  • Treatment of diseases which a hospital is not equipped for
  • Non-payment of transportation charges
  • Hospitals/doctors not following standard protocols
  • Doctors performing procedures needlessly
  • Hospital charging money even though it’s cashless scheme

Way forward

• As per Competition Commission of India (CCI) report- A significant proportion of out-of-pocket expenditure made by patients on medicine bills. The report cites public procurement as a solution, but its present levels are insignificant.
• It is in this backdrop that financial models like medical loans and crowdfunding have started to emerge and must further be pushed in an attempt to address the needs of the “unbankable” and make the system more inclusive.
• In the long run, AB-NHPM should envision strengthening of primary care, inclusion of out-patient treatment and a public healthcare delivery system, and expanding the scope of coverage to the entire population in order to make the government’s transition from provider to payer a successful one and achieve Universal Health Coverage in the true sense.
• All these measures taken together will help in regulating the hitherto unregulated hospital and healthcare sector and in making the health insurance sector a sustainable one.
• In the long run, the conversation on healthcare has to shift from pricing to sustainability and viability.