Day 68 – Q 2. Ayushman Bharat is one of the most ambitious health schemes ever launched in India. What can be the key challenges in proper implementation of this scheme?
2. Ayushman Bharat is one of the most ambitious health schemes ever launched in India. What can be the key challenges in proper implementation of this scheme?
Ayushman Bharat- National Health Protection Scheme (NHPS), aims to cover 10 crore families or approximately 50 crore population, with Rs 5 lakh insurance cover per family per year. The scheme is for secondary and tertiary healthcare, mainly for hospital care and is likely to benefit more than 37% of the population.
Challenges the scheme can face:
- Economic sustainability- Package rates fixed by the government are loss-making for hospitals. For example, the proposed cost of a coronary artery bypass graft (CABG) is about Rs.90, 000. The Central Government Health Scheme (CGHS) rates for this in Delhi are above Rs.1.1 lakh and private hospitals routinely charge above Rs.3 lakh.
- Infrastructure – The hospital business, particularly the multi-speciality tertiary care business, is capital-intensive with a long gestation period. There is severe shortage of infrastructure and government should provide adequate finances for the sector’s development and also provide incentives and tax benefits.
- Financing – Another challenge is that health is a state subject and hence requires states to contribute 40% of the expenditure for Ayushman Bharat. However, most states have a poor fiscal situation.
- Insurance- States have the option to select a “Trust” model that does not require insurers to participate. Where insurers participate, the auction may push premiums to unviable, low levels.
- Grievance redressal- The organisational committees that will deal with grievances of hospitals and insurers consist primarily of government representatives. Their chief focus will be to have patients’ claims paid and they have less incentive to solve the problems of hospitals or insurers.
- Payment issues- Under the trust system, there is less restraint on claims payment. Also, states are notorious for delaying payments and hospitals are concerned about payment cycles.
- Data issue- To calculate the odds of patients opting for a certain procedure in a certain district, for instance, the insurer must know the disease burden in that district. The government too must know this to be able to regulate insurers and service providers effectively. However, such data simply does not exist.
For the success of the programme, effective implementation is the key. For this an independent body or unit may be set up within the ministry of health & family welfare to plan, coordinate, and provide technical backstopping to states, including in capacity building and development of standards and guidelines for the programme.
Best answer: Point Nemo