If there is anything that could be a game changer in the next year’s General Election, it will be the “Ayushman Bharat” scheme which the Prime Minister officially launched it on 15th August 2018. Politics, counter politics, discussion, blame game, will all go on, but this is different and therefore one needs to have a serious in-depth analysis of the offerings.
PM Modi has touch the right cord, health and disease treatment is an emotive subject which touches people from all walks of life irrespective of their caste, creed and religion, while some of them being lucky and educated have already understood the importance of a health insurance and are covered by some form of insurance, but there are also few who are ignorant about it.
The Ayushman Bharat scheme is important especially during times when there are challenges and sudden emergency resulting in high out-of-pocket expenditure, low financial protection, no health insurance coverage amongst both rural and urban population. There is around 62.58 % of our population which are not covered through any form of health protection and therefore have to pay for their own health and hospitalization expenses, which ultimately leads them to use their income and savings, borrow money or sell their assets to meet their healthcare needs, thereby pushing 4.6% of the population below the poverty line. People with rural background, families having no adult member, female headed poor households with no adult male, landless households deriving their incomes from manual casual labor, SC/ST households are the initial candidates for this scheme and will therefore be insured for Rs. 5 Lakh per family per year (floater basis).
With the help of the Ayushman Bharat scheme the government intends to target 10.74 crore poor families per the latest Socio-Economic Caste Census (SECC) data (approx. 50 crore beneficiaries) in the first phase and then eventually cover lower middle class, middle class and even the upper middle class families, thus truly realizing the concept of Universal Health Coverage (UHC). Also there will be no cap on the size of the family, age of family members, 1,350 medical packages covering surgery including heart related coronary diseases and knee replacement, medical and day care treatments, cost of medicines, diagnostics will be covered and all pre-existing diseases will be covered. Patients can visit any public or private (empaneled) hospital across the country, coverage of pre and post hospitalization expenses. Patients can reach out for information, assistance, complaints and grievances to a 24X7 helpline number – 14555.
The planning of this program is in itself a case study for management and corporate students to study and analyze the multi-level, multi-prong, smart and holistic approach. Potentially Health sector has been a booming industry, but is a unique sector where people do not go by “choice” but by “need”. India is at forefront to cater this need, but there is a lot of immaturity in terms Infrastructure and fragmentation in health care services resulting in high and imbalanced medical expenditure and services. This is where Ayushman Bharat pitches in and has two inter-related components, the first one being the 1,50,000 Health and Wellness centers which will bring health care closer to the homes of the people. These centers will provide Comprehensive Primary Health Care (CPHC) covering both maternal and child health services, communicable diseases, including free essential drugs and diagnostic services, preventive, promotive and ambulatory health care services. The second component is the National Health Protection Mission (NHPM) which provides health protection cover to poor and vulnerable families for many critical life-threatening diseases mainly requiring hospital care and is referred as secondary and tertiary healthcare. The Health and Wellness centers will also play a critical role in creating awareness about AB-NHPM, screening for non-communicable diseases like hypertension, diabetes and some cancers.
Image Copyright – https://www.abnhpm.gov.in/
(NCD – Non communicable disease, RMNCHA – Reproductive, Maternal, Newborn, Child Health & Adolescent)
Now in order to execute, implement and run these wellness centers and NHPM across the country there will be large scale need of skilled manpower like doctors, nurses, technicians and support staff like certified Ayushman Mitra and ASHA workers thereby opening up opportunities for job creation. This whole scheme will be based on a robust IT infrastructure involving Nextgen technologies like Cloud, Artificial Intelligence, Machine Learning, etc. to make all the transaction cashless, paperless, flawless and transparent with fraud detection system to avoid leakage and corruption. For participation the government is already in a process to finalize the empaneled hospitals with capping of appropriate and affordable pricing for treatments, Insurance companies, Trusts / Societies and giving the kind of federal space and freedom for each states to make their choice for implementation of this program.
This is the kind of honest, hard work, smart thinking that the people expect from government’s across the board, acknowledging pain points and addressing them with innovative solutions and futuristic vision for people’s welfare.
Precisely the reason why BJP is winning state after state under Narendra Modi’s able leadership and if Congress can have a similar constructive solution for people’s problems it may once again stand a chance to rule the hearts of the Indians.
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