AYUSHMAN BHARAT – NATIONAL HEALTH PROTECTION MISSION
What is Ayushman Bharat Scheme?
- The Government announced two major initiatives in health sector, as part of Ayushman Bharat programme.
- Health and Wellness Centre
- National Health Protection Scheme
- Aimed at making path breaking interventions to address healthcare problems holistically, in primary, secondary and tertiary care systems.
- Covers both prevention and promotion of health.
Need for Ayushman Bharat
- India is in a state of health transition.
- Infectious diseases such as tuberculosis, malaria, dengue, H1N1 pandemic influenza and antimicrobial resistance are a threat.
- Also the country is facing the emerging problem of chronic non-communicable diseases such as cardiovascular diseases, diabetes, cancer which are now the leading cause of mortality.
- New factors are emerging that threatens the country’s health security like ageing population, climate change, globalization, urbanization and changing lifestyles.
- We lag behind in addressing healthcare delivery across the length and breadth of the country.
- We have one of the highest levels of out-of-pocket spending on health.
- Average cost of treatment in private hospitals is 4 times higher than that of public. This pushes many people below poverty line.
- Funding for healthcare has been a major concern.
- Several states have implemented or supplemented their own health protection schemes. Ayushman Bharat programme builds on these schemes.
- Failure of Rashtriya Swasthya Bima Yojana (RSBY).
- Poor families get an annual coverage of Rs. 30,000.
- It was world’s largest publicly-funded health insurance (PFHI) scheme.
- RSBY will be subsumed under National Health Protection Scheme.
- Similarly, Senior Citizen Health Insurance Scheme (SCHIS) will also be subsumed under NHPS.
Why RSBY failed?
- Failed to cover a large number of targeted families.
- Prevalent discrimination against disadvantaged groups.
- Lack of mandate on insurance companies to achieve higher enrolment rates.
- Absence of oversight by government agencies.
- RSBY resulted in higher out-of-pocket expenditures.
- This caused the failure of the scheme despite its holistic health care coverage.
Health and Wellness Centre
- Health and Wellness Centres will be the foundation of country’s health system.
- 1.5 lakh centres will bring health care system closer to the homes of people.
- Will provide comprehensive health care, including for non-communicable diseases and maternal and child health services.
- Will also provide free essential drugs and diagnostic services.
- Also provide mental health services, vaccinations against selected communicable diseases, and screening for hypertension, diabetes, and some cancers.
- Allocation of Rs. 1200 crore for this flagship programme.
- Contribution of private sector through CSR and philanthropic institutions in adopting these centres is also envisaged.
National Health Protection Scheme
- National Health Protection Scheme will cover over 10 crore poor and vulnerable families or around 50 crore people.
- Will provide coverage upto 5 lakh rupees per family per year for secondary and tertiary care hospitalization.
- Identification of eligible families through the socio-economic caste census (SECC) data.
- World’s largest government funded health care programme.
- National Health Agency will govern the implementing mechanism.
- Adequate funds will be provided for smooth implementation of this programme.
- Cost of packages will be decided by National Health Agency.
Significance of Ayushman Bharat
- Move towards the goal of universal health coverage
- Creating Swasth Bharat.
- Accessible healthcare at secondary and tertiary level institutions for the bottom 40% of the population.
- High involvement of states as the states are the custodians and the implementers of the scheme.
- Ensures enhanced productivity, well being and avert wage loss and impoverishment.
- Generation of lakhs of jobs, particularly for women.
- Like Jan Dhan scheme did for financial inclusion, Ayushman Bharat will create huge awareness of health insurance
- A higher life expectancy.
- The country will meet its social development goals.
- With respect to infrastructure and trained medical professionals, tertiary healthcare faces a big challenge. This problem is more acute in rural areas. AB will address this challenge.
- Will improve access to healthcare and bridge the demand-supply gap.
Challenges for Ayushman Bharat
- Inadequate funding.
- Proper and transparent implementation on such a large scale.
- Limited and uneven distribution of human resources at various levels of health services.
- Presently, a lack of capacity to respond to huge demand for beds. This will take some time.
- Private players faced various hurdles in earlier schemes like RSBY.
- There was opaque procedure for empanelment and cost fixating mechanisms.
- Huge delays in reimbursement to private hospitals was also a challenge in RSBY.
- At the same time, the pricing mechanism of private players needs to be checked.
- Politics of parties will hinder the participation of states.
- Categorise hospitals into Entry level, Progressive level and Accreditation level. This will help in standardisation in clinical practices.
- Use of technology and digitisation for accessible and affordable patient care to the last mile of the country.
- Need for proper medical claims system and fraud control mechanisms.
- Effective collaboration between centre, states and industry.
- States should have some flexibility as costs could vary in tier 1 cities and tier 2 cities.
- Proper monitoring and governance of operational and implementation aspect of AB.
- Timely resolution of complaints.
- Discuss the features of Ayushman Bharat programme and examine how Ayushman Bharat is different from Rashtriya Swasthya Bima Yojana.
- Critically examine the significances of and challenges in the implementation of Ayushman Bharat Programme.