Ayushman Bharat: The tools, the target and the significance

In this column, HE attempts to piece together some of the critical developments of PMJAY scheme available in the public domain.

The Indian healthcare system is extremely complex, and it often becomes challenging to track huge public policy initiatives of the government like Ayushman Bharat scheme. Having said that it's also imperative to wade through the complexity and make sense of the project.

Take, for instance, the recent tie-up with Uber. It was an event that a lot of newspapers reported and craving for some context about the significance of partnership. It is important to point out that several entrepreneurs hope that the benefits of the scheme will trickle down to the fraternity. It is also necessary to explain an increased partnership with the government, is considered as a benefit that can improve the scale of various innovations.

Even if you keep this context aside, it's important to ask some basic questions like, why tie up? It has been a challenge to identify urban candidates for the scheme. And the government is now trying to tap into the workforce of private companies to reach those who qualify for the five lakh annum health cover.

Has the government addressed the concern regarding frauds? Yes. Insurance Regulatory and Development Authority of India (IRDAI) and National Health Agency (NHA) will set up a joint working group for better implementation of Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY).

The working group will do a comparative study of packages and define standards for quality healthcare. It will also look into the management of the network hospitals, determining hospital infrastructure and facility audits to understand the capacity of hospitals and specialists availability.

The 11-member group will have representatives from both IRDAI and NHA. Dinesh Arora, Deputy CEO of NHA will chair the working group.

The news that volunteers appointed to assist patients under the Ayushman Bharat scheme could be brought under its payroll to fix direct accountability also made headlines. The Public Policy Research Centre conducted an assessment of the first phase of implementation of the PMJAY and suggested that instead of reporting to individual hospitals, Ayushman Mitra can be brought under the purview of the NHA to fix their responsibility.

What was the response by the government on targets for the next two months? Electronics and Information Technology (E&IT) Minister Ravi Shankar Prasad on Thursday set a goal for Common Service Centers to enrol five crore people under the Central government’s Ayushman Bharat healthcare scheme in the next two months.

What are the other questions that many wanted the government to answer?  It was definitely about the impact of the scheme. The Subnational Human Development Index (SHDI) for different States for the period 1990 to 2017 recommended the AB-PMJAY. “Once adequately rolled out and adopted across States, the schemes could improve the HDI value both at the national and sub-national levels in the coming years," stated the report published by the State Bank of India (SBI).

Finance Minister Arun Jaitley also said the PMJAY-AB is on its way to become the world's largest free healthcare scheme in just over five months of launch. "In just over five months of its launch #AyushmanBharat #PMJAY is well on its way to become the world's largest free healthcare scheme with - 2.2 crore people issued e-cards and over 14 lakh people treated," Jaitley said in a tweet.

Interestingly, through a ground study on the implementation of PMJAY, the Public Policy Research Centre, a Bharatiya Janata Party think tank, has found that not only has this helped the beneficiaries financially but has also brought healthcare services to a national focus and provided unprecedented accessibility and quality service to all.

With the leakage of government schemes becoming increasingly commonplace, it also recommended a few steps to make the plan more accessible. Should the volunteers who assist patients as part of PMJAY, be on the government payroll to fix direct accountability?

After evaluating the initial phase, authorities have suggested that instead of reporting to individual hospitals, the scheme could be brought under the purview of the NHA to fix their responsibility.

Creation of an Ayushman council on the lines of the GST Council to improve coordination between the beneficiaries and the government is another recommendation, which has been submitted to the NITI Aayog.

The expert committee interviewed patients, relatives government stakeholders, grassroots workers— ASHA workers, pharmacists and common service centres, among others before submitting the report.

The reasons why the scheme is considered beneficial are two. First, people are tending to healthcare problems on priority. Second, they are not delaying visits to doctors.

Several media publications also reported on the election health manifesto of Indian Medical Association, which pointed out that more private hospitals would participate in PMJAY if the government revises the current rate of the scheme.

Notably, there was also report about Union Minister Dharmendra Pradhan attacked the BJD government in Odisha alleging that Chief Minister Naveen Patnaik with depriving the people of the benefits of central schemes such as the Ayushman Bharat medical insurance plan.

It is also important to note that the Karunya Arogya Suraksha Padhathi (KASP) of Kerala government will cover injuries during a suicide attempt and alcohol-induced diseases. The new scheme with a maximum health coverage up to Rs 5 lakh is formed by integrating all healthcare and insurance schemes in the state, including the Centre’s AB-PMJAY and Karunya Benevolent Fund.

Lastly, one of the pieces also noted that in Karnataka, the government hospitals have earned an income of Rs 108 crore. These hospitals had a target of earning Rs 500 crore by the end of 2019 under Ayushman Bharat and Arogya Karnataka schemes. And this will clearly catch the attention of hospital managements.