Ayushman Bharat, the new, flagship health initiative of the government, has two dimensions.
Health & Wellness Centres (HWCs) :-
First, it aims to roll out comprehensive primary health care with Health and Wellness Centres (HWCs). HWCs would upgrade and increase the capacity of primary healthcare centres to provide care for a large range of chronic illness and infectious disease.
- A nationwide network of 1.5 lakh HWCs will be created by transforming the existing sub-centres and primary health-care centres by 2022 which will constitute the very foundation of New India’s health care system.
This will constitute the very foundation of New India’s health care system.
Providing Insurance – National Health Protection Scheme (NHPS) :-
The second dimension of Ayushman Bharat is the National Health Protection Scheme which aims to provide health cover of ₹5 lakh per family per year for hospitalisation in secondary and tertiary care facilities.
- 40% of total country population, neonates to young and old, will have access to facility care for almost all the medical and surgical conditions that could occur in a lifetime.
- It would align with what the State governments are doing already, with significant resources coming from the Centre.
- Many State governments would extend the benefits to additional beneficiaries through their own resources so that ultimately the population covered for catastrophic expenses could be two-thirds of India’s population, if not more.
- This mission enables increased access to in-patient health care for the poor and lower middle class.
- The access to health care is cashless and nationally portable.
- The scheme would enable a weaver in a remote village to be able to walk into a hospital for a gall bladder stone surgery or a coronary stent without having to pay the hospital.
- Treatment will be provided by empanelled public and private hospitals. Private hospitals will have to agree to terms such as package rates, adherence to standards and guidelines, ethical practice, respectful care and client satisfaction, and transparency.
Challenges – Primary Healthcare Focus :-
So far, The Country’s Primary Healthcare has been focusing on
- Reproductive, Maternal health, Newborn and Child health as well as controlling priority communicable diseases.All this perhaps covers only 15% of our needs.
- Public health action for preventive health has also been limited.
- There is a huge unmet need for primary health care, namely, care for non-communicable diseases (specifically, prevention and early detection and treatment of hypertension, diabetes, chronic obstructive lung disease, and common cancers), mental health, care of the aged, adolescent health, palliative health care, basic eye care and dental health.
Challenges – Health & Welness Centres (HWCs) :-
- With ₹1,200 crore supposed to be committed in the Budget for this, this would support only about 10,000 HWCs — less than 7% of what has been projected.
- The Current year’s health Budget shows no dedicated allocation for HWCs, rather this will have to be carved out of the existing NHM budget, which has itself seen a 5% cut compared to revised Budget estimates of last year.
Challenges – National Health Protection Scheme :-
- The funds allocated are grossly inadequate :-
The allocation of ₹2,000 crore to cover 50 crore households, amounting to barely ₹40 per person per year, is barely enough to cover one strip of tablets annually.
- This scheme would overlap with many established State health insurance schemes :-
Many large States already have established health insurance schemes, and for most requirements their existing allocations of ₹1.5-2 lakh were quite adequate.
- The scheme does not deal with preventive, pro-motive or outpatient care, so it is unlikely to lead to larger public health benefits :-
NHPS is not a move towards Universal Health Care since even in the best case scenario, 80 crore (60% of the population) would be left out, outpatient care (responsible for 70% of people’s expenditure) is not covered, and being focused on hospitalisation, there is no evidence that it would be integrated with primary level health care.
- In the absence of any effective regulation of the private sector, and given high levels of information asymmetry, the consumption of services is determined more by what private providers find more profitable to provide, rather than health-care needs of the poor.
Way forward :-
Health & Wellness Centres :-
- The first is an additional budgetary allocation of about ₹20 lakh per HWC per year, which would work out to about ₹30,000 crore per year. This would be great value for money.
- The second condition is a matching human resource policy — which includes in the least a regular salaried workforce of at least three auxiliary health workers per HWC. Also, reforms in the way that these 3 lakh health additional workers would be recruited, trained and retained, so that they are available where they are needed most.
- Third, this needs a well-coordinated referral mechanism with specialists and doctors in the secondary and tertiary hospitals.
Insurance gaps – NHPS :-
- Insurance does little for access to hospital care in vast areas where there are no providers. That needs public investment.
- The NHPS could play a useful role, as an alternative and more flexible financing route for tertiary care in both public hospitals and for purchasing care from a more public service and less commercially oriented segment of the private sector where there are critical gaps.
- It could have been designed to supplement rather than substitute the public hospital.
- Where States have already established insurance programmes, the NHPS could finance them, instead of replacing them And where they do not have a programme, The NHPS would have important contribution to make.