Why Ayushman Bharat May Be Modi Government’s Most Important Project So Far

The Prime Minister, in his Independence Day speech signalled the beginning of the Ayushman Bharat-National Health Protection Scheme (NHPS) by way of announcing the launch of Pradhan Mantri Jan Arogya Abhiyaan which would commence on the 25 September, later this year. Touted as the biggest government-funded health insurance programme in the world, Prime Minister Narendra Modi said that this “healthcare initiative will have a positive impact on 50 crore Indians”. He further linked health with poverty saying that “it is essential to ensure that we free the poor from the clutches of poverty!”

And what does Ayushman Bharat really mean to you, me, and a common Indian?
Statistics reveal that if an average Indian spends Rs 100 for a health problem, nearly Rs 70 is spent through his or her own pocket while government hospitals and existing insurance schemes provide for less than Rs 30 of the total expenditure. In light of this harsh reality, it is for the first time that the Government of India has committed to spend more than Rs 12,000 crore that will provide Rs 5 lakh of health insurance coverage to 10 crore families across India.

In a country where nearly 6 crore people are pushed into poverty each year due to catastrophic expenditure on health, such a wide-ranging health insurance coverage comes in as a game changer for improving the equity of resource distribution across the various strata of society. Also, to help identify and target the most needy families, the government has rightfully chosen the Socio-Economic Caste Survey to cater to 10.74 crore poor, deprived rural families, and identified occupational category of urban workers' families.

The premiums will be paid by the government with a 60:40 ratio between the Centre and state and both public and private hospitals will be empanelled to assure both access and quality of services to the target beneficiaries. Most importantly, Ayushman Bharat has an in-built flexibility in its design to allow for creative programming by states as per their local needs, with a large goal to promote a spirit of co-operative federalism. NHPS will cover nearly 22 medical packages to treat almost all secondary as well as tertiary ailments. Additionally, to control costs, the payments for treatment will be done on package rate. The above programme design is aimed to create a bottom-up demand for improved and timely delivery of medical services. The larger goal here is to encourage and opt for public hospitals over solely relying on private facilities for providing the designated medical package, at least in the rural areas which have lower paying capacities.

On the supply side, Ayushman Bharat plans to open thousands of health and wellness centres across the country. As opposed to previous insurance schemes, which unintentionally ended up creating a demand for expensive and unnecessary diagnostics and tertiary procedures in private hospitals, NHPS is well complemented by a strong focus on primary care, health prevention and Yoga. Moreover, India takes a leap from a medical definition of health which has prompted Indian healthcare industry to indiscriminately focus on secondary and tertiary care, towards an era of wellness and lifestyle modification.

This is especially significant in light of the fact, that India is currently facing a double burden of communicable diseases like tuberculosis, malaria and HIV amongst others but also a larger epidemic of non-communicable or lifestyle disorders like diabetes, heart disease and cancer. ‘Hum Fit toh India Fit’, Swaccha Bharat Abhiyan and the new Mental Healthcare Act have to be seen in the context of health promotion and its effect on improved health seeking behaviours.

As for the implementation, three key innovations have been made in the programme design to ensure effective delivery of insurance package. First is the use of barcode/QR code which can be swiped by the beneficiary to enable automatic deduction of government premiums and delivery of medical packages. This will ensure that the process is IT-enabled, transparent and timely.

NITI Aayog has already begun taking a lead on developing this IT infrastructure for the country. Second, thousands of ‘Ayushman Mitra’ are being trained to house each of the above-mentioned wellness centres. Ayushman Mitra will provide a special hand-holding approach to help inform and support various beneficiaries in availing their rightful entitlements. Third, for effective monitoring at the national level, an entity called the Ayushman Bharat National Health Protection Mission Agency (AB-NHPMA) would be set up while state schemes will be overseen by State Health Agency (SHA), thus institutionalising the standard protocols for service delivery.

Conclusively, Ayushmaan Bharat, as one of the largest public health initiatives across the world, is well suited to address both the unmet needs of the poor and an ailing population who were not previously able to pay for expensive medical treatments and is also geared towards addressing the social and economic determinants of health and well-being. Going forward, effective implementation, close monitoring and capacity building for human resource, especially in public healthcare facilities will be critical to improved health outcomes for the country. Moreover, “Healthy India” will not only be an end in itself but also go on to feed into improved productivity of workforce, ethical distribution of social services and human development, ultimately helping India to strive for achievement of sustainable development goals.