Ayushman Bharat is a progression towards promotive, preventive, curative, palliative and rehabilitative aspects of Universal Healthcare through access of Health and Wellness Centers (HWCs) at the primary level and provision of financial protection for accessing curative care at the secondary and tertiary levels through engagement with both public and private sector (PMJAY).

PMJAY recently completed 100 days of its implementation. The scheme covers 1,350 medical conditions ranging from caesarean section to coronary stenting and joint replacement. For each procedure, package rates have been fixed for different levels of hospitals.

The program certainly has a good intent of giving the best of the medical services at lowest prices to the economically weaker, deprived sections of the society. The program is fraught with many challenges that can hinder its outcome. The participation of Private sector is vital because

• Finance: At about 1.3% of the national income, India’s public healthcare spending between 2008 and 2015, has virtually remained stagnant. This is way less than the global average of 6 per cent. It is a herculean task to implement a scheme that could potentially cost Rs 5 lakh per person and benefit 53.7 crore out of India’s 121 crore citizenry, or roughly about 44% of the country’s population.
• Doctor-Density Ratio: The WHO reports the doctor-density ratio in India at 8 per 10,000 people as against one doctor for a population of 1,000.To achieve such access, merely increasing the number of primary and secondary healthcare centres is not enough.
• Poor healthcare ranking: India ranks as low as 145th among 195 countries in healthcare quality and accessibility, behind even Bangladesh and Sri Lanka.
• Healthcare Expenditure: Over 70 per cent of the total healthcare expenditure is accounted for by the private sector.
• Crumbling public health infrastructure: Given the country’s crumbling public healthcare infrastructure, most patients are forced to go to private clinics and hospitals. India falls woefully short of number of hospital beds compared to WHO standards. Secondary-level hospitals like district hospitals and medical colleges have poor infrastructure, especially the former.

However, the state and the people are wary of private healthcare sector being a part of PMJAY due to the following concerns:

• High Out of Pocket Expenditure: Most consumers complain of rising costs. 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).
• Commercial motive: lack of transparency and unethical practices in the private sector.
• Concentrated in Urban areas: Private 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.
• Better infrastructure needed: Under the PMJAY, the private hospitals have to get registered and fulfil the minimum requirements. They are also expected to expand their facilities and add hospital beds.
• Lack of level playing field between the public and private hospitals: This has been a major concern as public hospitals would continue receiving budgetary support. This would dissuade the private players from actively participating in the scheme.
• Additional incentives to the private players: The setting up hospitals in the underserved areas by private players can happen when there are incentives from the State. Lack of this would maintain status quo of last mile medical care which is in shackles.
• Populist measures of the government: The idea of bringing the Above Poverty Line (APL) population in the unorganised sector under ambit of scheme has been a bone of contention. A sizeable part would remain uninsured—mostly lower-middle class and middle-class households whose income-earning members work in the unorganised sector. The high cost of insurance as compared to PMJAY would deter this section from being insured.

Way Forward:

• The budgetary support being granted to public hospitals can be given as incentives to private players in underserved areas.
• The National Health Authority set up as an independent authority should provide for less interference from the government, thereby encouraging private players to participate.
• A binding policy commitment is imperative so as to reduce policy uncertainty and enable investments in hospital infrastructure by private players.
• Focus on Public-Private Partnership to reap the maximum benefits to citizens.

Conclusion:

PM-JAY seeks to accelerate India’s progress towards achievement of Universal Health Coverage (UHC) and Sustainable Development Goal – 3 (SDG3). 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.