Context

• The Pradhan Mantri Jan Aarogya Yojana (PMJAY) completed 100 days last week. The project is billed as the world’s largest state-funded health scheme.

• The medical journal, Lancet, has praised the prime minister for prioritising universal healthcare through the PMJAY, which aims to provide cashless treatment to beneficiaries identified through the Central Socio-Economic Caste Census.

Background

Ayushman Bharat

• Ayushman Bharat – National Health Protection Mission will subsume the on-going centrally sponsored schemes – RashtriyaSwasthyaBima Yojana (RSBY) and the Senior Citizen Health Insurance Scheme (SCHIS). It is an important reform and progressive step in healthcare sector.

• Ayushman Bharat is an initiative to Address Health Holistically inPrimary, secondary and Tertiary care Systems covering both Prevention and Health Promotion. The Scheme aims to provide cashless benefits of 5 lakhs to 10 Crore Poor Families in the Country.

• Ayushman bharat is the flagship public healthcare initiative of central government. It includes all the levels of healthcare delivery from primary to tertiary.

It has two components namely-

HEALTH AND WELLNESS CENTRE [HWC]

HWC’S will be upgraded form of primary health centres[PHC].the focus area includes non communicable diseases and infectious diseases along with neonatal and maternal care.HWC are primarily meant for early detection and prevention. This is significant in sense as burden on secondary and tertiary health system will reduce if early detection takes place, moreover rural areas will benefit as HWC will spread across India.

NATIONAL HEALTH PROTECTION SCHEME [NHPS]

NHPS is an insurance scheme which covers costing up to 5 lakh rupees per family per year for secondary and tertiary care hospitalization. It will cover 10 crores poor and vulnerable families. The scheme will reduce out of pocket expenditure and offers a choice for treatment at private hospitals.

Strategy of Scheme

• Establishment of Ayushman Bharat National Health Protection Mission Agency at National Level and State Health Agency to ensure proper implementation of Scheme at National,State and UT levels.

• The States and UTs can implement scheme through an insurance company or Directly through Trust/Society. This would increase Ambit of the Scheme at Ground levels.

Merits of Scheme

• A Strong Network of 1.5 Lakhs Health and Wellness Centers across the Country would constitute Foundation of India’s new Healthcare Systems.

• It will cover more than 10 Crore Poor and Vulnerable Families of the Society.

• The Support from Trained Nurses and Health Workers increase the Availability near Home in Rural Areas.

• Vulnerable Sections of the Society would have access to Healthcare to almost all medical and Surgical Conditions that can occur in Lifetime.

• Package Rates decided by Government for Private Hospitals would help in keeping the cost low.

• It will generate Employment Especially for Women would help in Economic Empowerment of Women.

Ground reality

• India ranks as low as 145th among 195 countries in healthcare quality and accessibility, behind even Bangladesh and Sri Lanka.

• The country spends an abysmal 1.3 per cent of its GDP on health, way less than the global average of 6 per cent.

• Over 70 per cent of the total healthcare expenditure is accounted for by the private sector. Given the country’s crumbling public healthcare infrastructure, most patients are forced to go to private clinics and hospitals.

• Health care bills are the single biggest cause of debt in India, with 39 million people being forced into poverty every year.

Can the PMJAY change that?

1. Shortage of Doctors and other infrastructures

• India falls woefully short of number of hospital beds compared to WHO standards. With over three-fourths of hospital beds being in the government sector, the private sector caters to a small segment of well-off population. So, from where will the beds for treatment under the scheme come?

• Currently, according to a government report, one allopathic government doctor attends to a population of 11,000 — the WHO recommends one doctor for a population of 1,000.

1. Budgetary allocations

The government has kept aside only Rs 3,000 crore for the PMJAY this year against the expected outflow of Rs 11,000 crore. How can then one expect adequate delivery of healthcare under PMJAY?

1. The intended beneficiaries of PMJAY are masons, contract workers and farm workers who cannot afford to take off much time for treatment at government or private PMJAY-recognised hospitals. OPD treatment is not covered under the scheme. Another issue, quite unforeseen, is difficulty in locating beneficiaries.

Additional problems with healthcare delivery

• Secondary-level hospitals like district hospitals and medical colleges have poor infrastructure, especially the former.

• The tehsil and district hospitals have inadequate equipment and lack specialist manpower.

• Not even one of the 20 medical colleges in India offers cardiac bypass surgery. There is also a gross shortage of tertiary care hospitals in the public sector with PGI, AIIMS, SGPGI and NIMHANS being among the few that can be relied upon.

• However, these public hospitals are functioning beyond their capacity with waiting lists of one or two years for elective surgeries.

Can the private sector be depended upon? 

1. Most consumers complain of rising costs, lack of transparency and unethical practices in the private sector. Moreover, these hospitals don’t have adequate presence in Tier-2 and Tier-3 cities and there is a trend towards super specialisation in Tier-1 cities.

2. Under the PMJAY, the private hospitals have to get registered and fulfill the minimum requirements. They are also expected to expand their facilities and add hospital beds.

3. Hundred days into the PMJAY, it remains to be seen if private hospitals provide knee replacement at Rs 80,000 (current charges Rs 3.5 lakh) bypass surgery at Rs 1.7 lakh (against Rs 4 lakh).

Way Forward

1. The PMJAY has created an excellent opportunity for the country to improve its health care.

2. While the contribution of the private sector will be the key to its success, it’s the will and zeal of the government to implement it that will make or break the scheme.