India launches world’s largest public funded healthcare scheme

October 15, 2018 0 By CH Unnikrishnan

India, a country of 1.3 billion people with just a fraction of them covered under medical insurance, has kick-started the world’s largest public funded healthcare programme — Ayushman Bharat – Pradhan Mantry Jan Arogya Yojana. The scheme is expected to benefit around 10 crore economically backward families with an annual healthcare coverage of Rs 5 lakh each and aims to cover around 550 million people across the country.

As announced on the country’s 71st Independence Day in August, Prime Minister Narendra Modi launched the programme on September 23 in Jharkhand. Launching the scheme at the state capital Ranchi, the Prime Minister said: “It is a big step towards providing good quality and accessible healthcare to the poor of India.”

As per the nationwide launch plan, nearly 31 states and Union Territories will implement the programme now. As part of the launch, the Prime Minister also inaugurated 10 wellness centres in Jharkhand.

“The government is pursuing a holistic approach towards the betterment of the health sector. As it focuses on affordable healthcare on one hand, emphasis is also being laid on preventive healthcare on the other,” Modi said, while launching the programme.

“This is the world’s largest such scheme and the number of Ayushman Bharat beneficiaries is almost equal to the population of Canada, Mexico and the US put together,” Modi added.

The scheme became operational on September 25 on the birth anniversary of Pandit Deendayal Upadhyay and will be funded with 60% contribution coming from the central government and the remaining from the states. Five states, including Telangana, Odisha, Delhi, Kerala and Punjab, are yet to sign the agreement on the scheme with the centre.

Eligible people can avail the benefits in government and listed private hospitals. The beneficiaries are identified based on mainly four “deprivation” categories. They need to establish their identity to avail benefits under the scheme and it could be through Aadhaar card or election ID card or ration card.

In case of hospitalisation, members of the beneficiary families do not need to pay anything, provided they go to a government or an empanelled private hospital.

Even as the healthcare industry welcomed the historical launch of the scheme, it reminded the government that there are areas that need to be addressed to ensure that such a large-scale health-cover programme is successfully implemented.

“On the historic launch of the world’s largest health coverage scheme – Ayushman Bharat, I feel as happy as I did when we launched the first universal insurance scheme in my village in the year 1999. I am also filled with a sense of anticipation on the positive effect this scheme will have on the health of the 50 crore beneficiaries,”said Pratap C Reddy, founder and chairman of the country’s largest corporate hospital chain, Apollo Hospitals.

“While we all work together to ensure the success of this scheme, there are areas that need focus and fine tuning. These include ensuring the robustness of the IT backbone, weeding out potential fraud, ensuring coverage to only identified beneficiaries and ensuring more adoption by the private sector, who are rightly worried about the pricing and reimbursements. These issues must remain paramount moving forward,”he said, adding that he strongly believes that the scheme is for the greater public good and everyone must strive to ensure its success.

Earlier, after the first announcement of the programme in August, Tedros Ghebreyesus, Director General of World Health Organisation, lauded the initiative by the government of India, calling it a great commitment.

However, healthcare industry consultants have expressed concerns about the lack of clarity in the budgetary allocation and the availability of funds. There are also concerns about the extent of geographical coverage
and the paucity of accredited hospital capacity.

Mumbai-based healthcare industry consultant and Future Medicine columnist Muralidharan Nair had earlier shared his views saying the operational success of the programme will be contingent upon customising the programme to address the  ground conditions, which vary significantly from state to state and even within the state.

“This includes the availability of relevant human resource, the maturity of private providers, public health capability, morbidity profile and the cost of care. I am certain, the learned managers of this programme are fully seized of this matter, but I have a few other concerns too,” he wrote in a previous column.

It is imperative that a complex programme like this depend heavily on technology support for effective execution, be it for process efficiency, process integrity, fraud prevention, optimization strategies or customer feedback. It is unlikely that the technology capabilities will be fully deployed before a while, and importantly, given the rural reach that is planned. Therefore, it is crucial that there is a robust plan for the interim and a sustainable operational ecosystem for carrying out technology operations in the future, Nair added.

The critics of the Central programme say that State cooperation is important for successfully implementing a programme of this scale. Since the many of them are still not in agreement, it may have a negative impact on the nation roll out of the programme.

While Odisha government has already rejected the programme saying the existing state government programme–Biju Swasthya Kalyan Yojana covers many more people than Ayushman Bharat and provides Rs. 7 lakh to women as opposed to the central programme’s Rs. 5 lakh, the Southern state Kerala was critical about the feasibility of the new central programme. Delhi and Telengana states were also in disagreement with Ayushman Bharat. WhileTelangana rejected the scheme on the grounds that its Aarogyasri scheme covers 70 per cent of the state’s population while the Ayushman Bharat will only benefit 80 lakh people, Delhi government said the central programme’s proposed target of 6 lakh families covers just 3 per cent of its 2-crore population. Similarly, the state of Punjab had also held certain reservations against new health coverage scheme launched by the Centre.