Operation Ayushman Bharat: How will the government steer its Flagship Project?

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What do challenges affecting the implementation mean for the government’s plan to deliver Ayushman Bharat this August? We look at some of the big questions confronting authorities in the days and weeks ahead.

 

Early this year, the government surprised the country when it announced its upcoming social welfare scheme, Ayushman Bharat. The plan would expect empanelled hospitals to have NABH or equivalent quality and accreditation. In a state where most patients pay out of pocket for healthcare, the project sounds too good to be true.

In recent months, the healthcare sector has seen a surge of interest from local and international players. National and foreign investors’ fascination with the insurance scheme explains the spur in the M&A activities in the healthcare sector. According to the data from a recent brokerage report, the healthcare industry is expected to grow 16-17 percent annually, reaching Rs 8.6 trillion by FY22 with the help of NHPS.

It is no secret that India’s public healthcare system is a mess. Currently, India has just 0.7 beds per 1,000 people; the WHO recommends 3.5. Even in the financial capital of the country, Mumbai, 52.5% of the population lives in slums that are often hotbeds of several infectious diseases. In fact, a recent report about Govandi (an informal settlement in Mumbai), revealed that every 10th person has TB. These statistics have spurred debates across the country. In the context of Ayushman Bharat, the new scheme offers hope to many who think that it would act as a catalyst for the broken public health sector.

It is still far from clear which government promises will translate into solutions. According to sources, the National Health Protection Scheme will be implemented through four bodies: The National Health Protection Council (NHPC), the National Governing Body (NGB), the National Health Authority (NHA) and State Health Agency (SHA).

IN PURSUIT OF THE PERFECT MODEL

Despite the ambitious strategy to roll Ayushman Bharat out soon, implementation has proved harder than expected. There are two proposed models for implementing the scheme: trust and insurance.

In the trust model, the state health agency will perform tasks like beneficiary identification, administration, hospital management, hospital empanelment as well as claims management.

In the insurance model, an insurance company will do hospital management and claims management.

 
 

Option 1: Trust Model: What will it mean for Healthcare?

Option 2: The Insurance Model Edition

Delhi has said little publicly so far about the empanelling of hospitals, but many insiders confirm a four-prong strategy to make it work. First, all CHC and above public hospitals would automatically get empanelled. Second, private hospitals will be empanelled based on defined criteria. Third, the responsibility of empanelment will be of the State Health Agency. Fourth, an online system of hospital empanelment would be used by all hospitals.

These are early days for the scheme, but it is a widely-held assumption that the payments for treatments will be processed as packages. So, when a beneficiary visits the hospital for treatment, the hospital will carry out Aadhaar-based verification, check the balance from a central server and take pre-authorisation wherever required.

 
 

HEALTH AND WELLNESS CENTRES, AKA PHC 2.0

If there is a ray of light at the end of the tunnel it is the fact that the National Health Protection Scheme is only one of the two pillars of the Ayushman Bharat programme.

The second pillar is Health and Wellness Centres (HWC) that will provide comprehensive primary Healthcare, including NCD screening, and will bring primary care closer to the people. In other words, it will be a PHC 2.0. HWCs will offer services to patients for communicable, non-communicable diseases, maternal, child and family welfare and essential drugs and diagnostics. And, according to the official twitter handle of Ministry of Health, an HWC will consist of a waiting area for more than 30 people, storage space for medicine and consumables, telemedicine facilities, consulting spaces to ensure privacy, plus wellness rooms for yoga, physiotherapy and group meetings.

EARLY DAYS

Given time, the authorities will be able to make the customs arrangements for Ayushman Bharat work effectively. But sources say that there are few pitfalls, which the agencies are trying to avoid, to ensure that the scheme would do well.

First, while designing packages, surgical procedures top the list of the majority of state schemes like RSBY. The transition from state schemes to NHPS will require clarity on details of medical, pediatric and emergency treatments, which are currently not laid out for these state schemes. Second, without breakthroughs on issues of rural-urban divide, corporate hospital-smaller chains, it will not give the government the green light it wants for future ties.

The implementation of a national insurance scheme is not going to be easy, despite what politicians say. Many say that the best place to start is by fixing primary healthcare.

"Late detection of diseases only creates more burden on the social and financial lives of the people. Why can’t we have a robust system of treating a wound at the PHC level, and why are we immediately thinking of it going septic and providing the patient with the choice to go to a super speciality hospital for its treatment?” asks Dr Shankar Narang, COO of Paras Hospitals.

As Alok Kumar, from Niti Ayog, puts it: “Health and Wellness Centres are in fact the most integral element of the scheme, but no one’s paying attention to this. It will enable better access to care and reduce the costs of healthcare.”

At this point, the question is not so much how Ayushman Bharat can improve the health care sector; it is how can Ayushman Bharat be successfully implemented. We will have to stay tuned for updates.

 

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