Striking a Healthy Balance with Ayushman Bharat

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It’s time to get real about the future of Ayushman Bharat, a subject in desperate need of discipline. The opportunities of the scheme have inebriated various seers: propagating bold forecasts or spinning tales about how much it will transform Indian healthcare.

Take the example of the World Health Organization (WHO) Director-General. He has praised Prime Minister Narendra Modi and Health Minister J P Nadda for their visionary leadership which helped around seven lakh people avail benefits of the healthcare scheme Ayushman Bharat in the first 100 days of its launch.

"In its first 100 days, #India's ambitious #AyushmanBharat scheme has provided free care for almost 700,000 people. I applaud Prime Minister @narendramodi and Health Minister @JPNadda for their visionary leadership for #HealthForAll (sic),” Director General Tedros Adhanom Ghebreyesus tweeted.

On the impact of the scheme- Finance Minister Arun said on an average 5,000 claims are being settled every day since its rollout on September 23, 2018.

The second reality to remember regarding the scheme is the fact that the total number of hospitals covered by this scheme is 16,000 and increasing steadily. More than 50 percent of the implementing hospitals are in the private sector.

Finance Minister Arun Jaitley said in the first 100 days, 6.85 lakh patients have been provided hospital treatment and 5.1 lakh claims have availed of the scheme, for which payment has been released.

Prime Minister Narendra Modi launched the Ayushman Bharat scheme in September.

Earnest discussions of how Ayushan Bharat will make Indian healthcare a utopia often miss the point that the success will depend on integration with state-run schemes.

Delhi Chief Minister and AAP National Convener Arvind Kejriwal claimed that Ayushman Bharat is a public relation exercise which will prove to be another "jumla". The Aam Aadmi Party (AAP) termed the scheme "another white elephant in the making" and alleged that it covers only six lakh out of 50 lakh families in Delhi. 

Finance Minister Arun Jaitley had pointed out in his blog on 100 days of Aayushman Bharat that in the first 100 days, 6.85 lakh patients have been provided hospital treatment. 5.1 lakh claims have availed of the scheme, for which payment has been released. This averages 5000 requests per day for the first 100 days. No patient has had to pay a single Rupee.”

The objective of Pradhan Mantri Jan Arogya Yojana is to attain coverage of at least 75 percent of the population with publicly financed health insurance covering most secondary and tertiary care procedures by 2022-2023. The other objective is to reduce by 50 per cent the proportion of households facing catastrophic healthcare expenditure from the current levels, states a report titled Strategy for New India published by NITI Ayog.

The World Bank says rising expenditure on private healthcare is keeping millions of Indians on poverty. Sixty per cent of the 60,000-70,000 public/private hospitals in the country have less than 30 beds, and only some 3000 of them have 100 or more beds. India has two million hospital beds, which is merely one per 625 people. The Union Government promises to bridge this gap by providing healthcare to 100 million of India’s most impoverished families.

If Indians had the money, the scheme wouldn’t matter, but many can't afford expensive healthcare services. At the billing section of  Sri Ramachandra Institute of Medical Science, Chennai one can see patients from different states. *Padma, one of the patients, confirms this trend of flow of patients from the North Eastern States. “The hospital gets many patients from the North Eastern States, especially for specialities like Oncology. Whenever I come for doctor visits, I spot several patients with their families waiting at the reception or the oncology departments,” *Padma adds.

In many ways, India's tryst with Ayushman Bharat represents a Bildungsroman for the middle class. Public health infrastructure in the country expanded considerably following the launch of the National Health Mission in 2005. However, there seems to be a shortfall in several areas. In 2015, the number of sub-centres fell short of requirements by 20 per cent, of primary health centres by 22 per cent and community health centres by 32 per cent in rural India.

Pradhan Mantri Jan Aarogya Yojana was rolled out on September 23, two days ahead of the birth anniversary of Rashtriya Swayamsevak Sangh (RSS) idealogue Pandit Deen Dayal Upadhyaya.

Interestingly, according to news reports, the number of hospitalisations under Ayushman Bharat has more than doubled in the last three months with tertiary care procedures such as Angioplasty, Joint and Valve replacement as well as cancer care accounting for 77 percent of the Rs 897 crore pre-authorised for hospitalisation under Ayushman Bharat.

Dr VK Paul, NITI Ayog, recently pointed out at a healthcare event, that 80 per cent of the population of Ayushman Bharat has already been identified.

The average number of beneficiaries admitted to hospitals increased to 10,000 per day in December from around 2,000-5000 in October. The compounded monthly growth in the number of hospital admissions under the scheme is estimated at 47 percent since October, according to available data. A total of 6.73 lakh patients have sought hospitalisation under the project so far since its launch on September 23.

States like UP, Bihar and Jharkhand where health indicators have been poor, show a significant jump in the number of hospitalisations. UP recorded a 70 per cent increase in hospital admissions under the scheme in the last month, Jharkhand recovered 67 percent, whereas it rose by more than 50 percent in Bihar.

Emboldened by the success of the scheme, the government set its sights even higher. The first beneficiary of the scheme was a Haryana woman who delivered a baby girl at the Kalpana Chawla Government Hospital in Haryana’s Karnal area through C-section.

However, just offering a scheme is not enough, the rates also need to attract the corporate hospitals. Several hospitals are battling poor financial health and fought heavy losses. Columbia Asia Hospitals Pvt Ltd has sold one of its hospitals to Zydus Hospitals for an undisclosed amount.

Furthermore, the government also face an uphill task with states negotiation lower premium rates.  NITI Ayog had proposed a premium of Rs 1032 per family under the Ayushman Bharat scheme. However, that doesn't mean that they don't have an appetite for the plan. As many as 22 states have adopted the trust model, while others have selected for the hybrid model where the programme will be managed jointly by insurance companies and state.

The arrival of PM JAY has also sparked meetings of private doctors with NITI Aayog members. Many think, it is not a sustainable model for states, which already have their scheme and have higher rates.

Another interesting factor is that, none of the big private hospitals in Mumbai is on board. It remains to be seen if these ‘out-of-the-box’ ideas will be implemented or not and how soon, but these developments are a testimony to the government’s ongoing efforts to boost healthcare sector in India which indeed is an urgent need for our nation.