Context: Mainstreaming innovation in health care system in India.

Ayushman Bharat:

• Ayushman Bharat, a flagship scheme of Goverment of India was launched as recommended by the National Health Policy 2017, to achieve the vision of Universal Health Coverage (UHC).
• This initiative has been designed on the lines as to meet SDG and its underlining commitment, which is "leave no one behind".
• Ayushman Bharat is an attempt to move from sectoral and segmented approach of health service delivery to a comprehensive need-based health care service.
• Aim of Ayushman Bharat: The aim is to undertake path breaking interventions to holistically address health (covering prevention, promotion and ambulatory care), at primary, secondary and tertiary level.
• The scheme adopts a continuum of care approach, comprising of two inter-related components:
• Health and Wellness Centres (HWCs)
• Pradhan Mantri Jan Arogya Yojana (PM-JAY)

Health and Wellness Centres (HWCs): The Government of India in 2018 announced the creation of 1,50,000 Health and Wellness Centres (HWCs) by transforming existing Sub Centres and Primary Health Centres. 

Pradhan Mantri Jan Arogya Yojana (PM-JAY):

• The second component under Ayushman Bharat is PM-JAY, which aims at providing health insurance cover of Rs. 5 lakhs per family per year for secondary and tertiary care hospitalization to over 10.74 crores poor and vulnerable families (approximately 50 crore beneficiaries).
• There is no cap on the family size under the scheme.
• This scheme was earlier known as National Health Protection Scheme (NHPS) before it was rechristened to PM-JAY.
• PM-JAY has been rolled out for the bottom 40% of poor and vulnerable population.
• The households included are based on the deprivation and occupational criteria of Socio-Economic Caste Census 2011 (SECC 2011) for rural and urban areas respectively.
• The scheme subsumed then existing Rashtriya Swasthya Bima Yojana (RSBY), launched in 2008.
• PM-JAY is completely funded by the Government, and cost of implementation is shared between Central and State Governments.

Present Status of its implementation:

• The scheme is currently being implemented in 32 of 36 States and Union Territories.
• It has provided 84 lakh free treatments to poor and vulnerable patients for secondary and tertiary ailments at 22,000 empanelled hospitals, countrywide.
• Under PM-JAY, there is one free treatment every three seconds and two beneficiaries verified every second.
• At present, there is one government bed for every 1,844 patients and one doctor for every 11,082 patients. 

Need of innovation in Indian health care system:

Considering 3% hospitalisation of PM-JAY-covered beneficiaries in coming years, the scheme is likely to provide treatment to 1.5 crore patients annually. This means physical and human infrastructure capacity would need to be augmented vastly. It has been estimated that India would need more than 150,000 additional beds, especially in Tier-2 and -3 cities. While a comprehensive long-term strategy will focus on expanding hospital and human resources infrastructure, an effective near-term approach is needed to improve efficiencies and bridge gaps within the existing supply and demand.

Thus, a potential for accelerating health system efficiency and bridging the gaps of supply and demand, there is need of mainstreaming innovation in the Indian health system.

Mainstreaming of health-care innovations:

• Start-ups are working to bring innovative technologies and business models that leapfrog infrastructure, human resources, cost-effectiveness and efficiency challenges in Tier-2 and -3 cities. There are more than 4,000 health-care technology start-ups in India.
• Leveraging disruptive technologies like artificial intelligence, robotics, internet of things, healthcare aggregators are delivering top class affordable medical facilities to people in terms of diagnostic equipment, imaging, and telemedicine.
• Innovations in the areas of new drugs, vaccines, diagnostic tests, telemedicine have also enhanced patient care and contributed towards enhanced quality of overall delivery of healthcare services. Healthcare providers and start-ups are coming up with innovative solutions to enhance patient care.
• The innovative practices hold huge significance in the wake of spurt in non-communicable diseases (NCDs) like cancer, stroke and heart related issue in recent years. According to WHO report, nearly 61 per cent deaths are attributed to NCDs.
• Series of innovative practices have been adopted by States like Rajasthan, Andhra Pradesh and Madhya Pradesh to strengthen healthcare delivery system enabling people quality and cost-efficient medical facilities at their doorsteps. Taking cue from these innovative ideas, many others States are striding towards enhanced healthcare delivery model.

Challenges faced in mainstreaming innovation in health care system:

• Non-uniform regulatory and validation standards: Regulatory requirements, specifically for biomedical start-ups, are still evolving in India. Hospitals often rely on foreign regulatory certifications such as FDA and CE.
• Huge variation in validation requirements: It is difficult for a start-up to understand the minimum necessary validation requirements in order to qualify for procurement by hospitals. 
• Long gestation period: Health-care start-ups spend long periods of time in the early development of their product, especially where potential clinical risks are concerned. The process of testing the idea and working prototype, receiving certifications, performing clinical and commercial validations, and raising funds, in a low-trust and unstructured environment makes the gestational period unusually long thereby limiting the operational liquidity of the start-up.
• Lack of incentives: Health-care providers and clinicians, often lack the incentives, operational capacity, and frameworks necessary to consider and adopt innovations. 
• Procurement challenges: Start-ups also face procurement challenges in both public and private procurement. They lack the financial capacity to deal with lengthy tenders and the roundabout process of price discovery.

Way Forward:

• The partnership between National Health Authority (NHA) and the Healthcare Federation of India (NATHEALTH) which aims to streamline all innovations ensuring that it increases the efficacy of service delivery of Ayushman Bharat-Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) is a step in right direction.
• The collaboration will provides an industry interface for testing innovations, providing mentorship and creating channels for facilitating support required for scaling these innovations. 
• Further, there is need to focus on identifying promising market-ready health-care innovations that are ready to be tested and deployed at scale.
• Also, there is a need to facilitate standardised operational validation studies that are required for market adoption, to help ease out the start-up procurement process such that these solutions can be adopted with confidence. 

Conclusion:

The launch and expansion of Ayushman Bharat-PM-JAY is a watershed moment for the Indian health-care service delivery ecosystem. AB-PMJAY will help in exploiting the potential of collective bargaining and leveraging economies of scale. This could deliver more affordable and quality healthcare by negotiating better prices for various devices, implants and supplies, and also leveraging other policies such as Make in India. However, technological innovations in healthcare need to be backed by a robust policy framework.