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Prime Minister Narendra Modi on Sunday launched Ayushman Bharat, or Pradhan Mantri Jan Arogya Abhiyan (PMJAY). The scheme aims to extend affordable health coverage to poor people. Its noble goals aside, there still has to be some clarity over what exactly the scheme offers and how it will work out.
Being touted as the world’s biggest government-sponsored healthcare scheme, it is projected to cover 10 crore families. The scheme offers a defined benefit of Rs 5 lakh per family per year for secondary and tertiary hospitalisation through a network of Empanelled Health Care Providers.
Indian version of Obamacare?
Many dubbed the scheme as Modicare, giving rise to speculations that something similar to the American Obamacare is being offered to Indian citizens. However, that is not the case.Obamacare, officially named Patient Protection and Affordable Care Act, covered about 18% of the US population, but the Indian scheme aims to cover around 37% of Indian population. The estimated cost of Ayushman Bharat is pegged at Rs 4000 crore, and the Centre has already announced allotment of Rs 2000 crore, and some reports suggest that it may rely on the states to cough up the rest 2000 crore. (If the government makes the scheme universal, it will cost an additional Rs 1070 crore).
For Obamacare, the cost in 2012 itself was $ 1.76 trillion according to Congressional Budget office. (President Obama claimed it cost $940 billion). The difference does not just end with costs. A unique feature of Obamacare is that it also applies to restaurants and ice-cream parlours as the law makes it mandatory for eateries to display the calorie content of their dishes on the menu. Last but not the least, Obamacare covered around 2.5 crore people, whereas Ayushman Bharat aims to covers around 50 crore individuals.
Implementation
One of the core principles of Ayushman Bharat - National Health Protection Mission is to foster cooperative federalism and give flexibility to states. The plan envisions setting up Ayushman Bharat National Health Protection Mission Council (AB-NHPMC) at apex level to give policy directions and coordinate the implementation of the scheme. This body will be chaired by Union Health and Family Welfare Minister. At the state level, the states will have to form State Health Agency (SHA) to implement the scheme. Additionally, to ensure a smooth and timely flow of funds from centre to states, it is proposed that the transfer of funds from Central government to State Health Agencies may be done directly through an escrow account. The mechanism also includes a dedicated IT platform which will be built in partnership with Niti Ayog to enable paperless, cashless transactions.
Possible hurdles
It is no doubt an ambitious plan, and could face some hurdles during execution. One of the biggest problems could be financial sustainability for stakeholders such as insurance companies and hospitals. Some hospitals have stated that the packages fixed by the government for treatment are loss-making. Secondly, the committee that will look into grievances of hospitals and insurance companies will comprise mainly of government representative-and their goal will be to get the patient’s claims paid. This might again hurt the interests of those who offer medical coverage and services.
Secondly, the total number of hospital beds in the country is around 1.5 million, and the number of insured people will be around 500 million. Suffice to say the hospitals will need to build their capacity. Fortunately, the new scheme makes it mandatory for the hospitals to maintain certain minimum standards, including a particular level of technology. Ayushman Bharat is expected to give a boost to health infrastructure too.
