India is in the middle of health transformation. Although infectious diseases like tuberculosis, malaria, dengue, H1N1 pandemic influenza and antimicrobial resistance continue to pose health and economic burden, the country is also facing challenges with chronic non-communicable diseases, such as cardiovascular diseases, diabetes, cancer; which are the leading cause of mortality. Social and economic determinants of health along with demographic changes, such as an ageing population, environmental factors, such as climate change, and factors like globalization, urbanization and changing lifestyles are also contributing to this epidemiological switch. (1)
In order to overcome the current healthcare challenges and also to lessen the strain on healthcare infrastructure, the Government of India recently rolled out a mammoth scheme, considered to be the largest in the world, intended to provide free health insurance to India’s poor and marginalised families. This scheme has been named Pradhan Mantri Jan Arogya Yojana (PMJAY) or Ayushman Bharat and is also often referred to as ‘Modicare’. This government-sponsored health insurance scheme, available for 10.74 crore beneficiary families and about 50 crore Indian citizens under the National Health Protection Scheme (NHPS) flagship program, will provide free annual coverage of up to Rs. 5 lakh per family at any government as well as a few of the empanelled private hospitals pan-India. However, the scheme is meant only for poor and economically-deprived people and not everyone can be eligible to get free medical insurance under this scheme. (2) This flagship program is intended to benefit over 37% of the population, covering nearly all the poor and vulnerable families. The government has allocated a budget of Rs. 12,000 crore for implementing this initiative, with cost shared on a 60:40 basis between central and state governments. (2,3)
Here are some key benefits of the Ayushman Bharat scheme:
- No limit on age/gender/size of the family
- Automatic coverage to all members of eligible families as present in SECC
- No hospitalization cost borne by the family
- All pre-existing conditions covered from day one of the policy
- The benefits covered include pre- and post- hospitalisation costs
- Scheme available for free treatment at public or empanelled private hospitals across the country
- A prescribed ID mandatory to receive treatment at the hospital
More details are available on the Ayushman Bharat website (https://www.india.gov.in/spotlight/ayushman-bharat-national-health-protection-mission). (2)
The Ayushman Bharat initiative seems to be driven by two main objectives, i.e. to strengthen primary healthcare that the country lacks as well as to offer financial safety from disastrous expenditure, often encountered when one seeks long-term healthcare. (1)
While this scheme is an attempt at ensuring the accessibility of universal healthcare for the weaker section of the society, the current outline of the scheme doesn’t seem beneficial for people seeking tertiary care as the compensations under the scheme are not sufficient to avail value based care. Today, almost 80% of Indian healthcare is provided by the private healthcare system. Therefore, to meet the escalating healthcare needs of Indian population through value based medicine, the country needs a harmonized effort by both private as well as public sectors. For instance, the scheme requires hospitals to maintain certain minimum standards. The reward to hospitals is 10% higher if they have National Accreditation Board for Hospitals and Healthcare Providers (NABH) accreditation and a basic technology criterion is in place for hospitals to be qualified for this scheme. Hospitals that meet these quality benchmarks must be permitted to serve NHPS beneficiaries. Quality should be assessed not only by the infrastructure offered at the hospital, but also by reliable patient outcomes accomplished. (4) Moreover, such an extensive program must give due attention to all the aspects of effective healthcare delivery. Therefore, it is crucial for Ayushman Bharat as well as the Pradhan Mantri Rashtriya Swasthya Suraksha Mission (PMRSBM) – a centrally sponsored ongoing initiative, aimed at taking India towards Universal Health Coverage (UHC) – to be supported by Health Technology Assessment (HTA), since medical technology is also a critical aspect in healthcare delivery and India has recently started progressing on HTA with Medical Technology Assessment Board (MTAB) [(Department of Health Research (DHR)] (5) taking lead. (6)
With healthcare never making it to a priority with any political party until now, we are glad to see some positive steps being taken towards addressing the healthcare concerns, be it National Health Policy (NHP) 2017 and/or Ayushman Bharat initiative. (7) This initiative is pioneering in the history of public health in India, which may have a significant impact if implemented in an effective and harmonized manner. We are still quite far from making quality healthcare accessible, but we need to take up the challenge and make way for a correct system for people to have access to the right treatment at the right time notwithstanding their economic status. In the near future, Ayushman Bharat should aim at strengthening the primary care, incorporating outpatient treatment and outlining the general healthcare delivery with a specific end goal in order to facilitate the achievement of Universal Health Coverage. (1,4)
- Narain JP. Is Ayushman Bharat a game changer? August, 2018.
- Ayushman Bharat- National Health Protection Mission.
- Ayushman Bharat for a new India-2022 announced. Ministry of Finance- Government of India. February, 2018.
- BS Ajaikumar. Ayushman Bharat: Scheme has potential to change India’s healthcare landscape but there are major hurdles on the way. October, 2018.
- Department of Health Research- Medical Technology Assessment Board. Ministry of Health & Family Welfare: Government of India.
- Kumar S. Medical Technology is a cogwheel to Ayushman Bharat Programme: Dr Sanjiv Kumar. July, 2018.
- Bakshi H, Sharma R, Kumar P. Ayushman Bharat Initiative (2018): What we Stand to Gain or Lose! Indian Journal of Community Medicine : Official Publication of Indian Association of Preventive & Social Medicine 2018; 43(2):63-66.