0.1602
900 319 0030
x

Concerns in Ayushman Bharat

iasparliament Logo
December 28, 2018

What is the issue?

  • The Ayushman Bharat-National Health Protection Mission (AB-NHPM) needs a relook, given the implementation concerns with it.
  • Click here to know more on the scheme.

Why AB-NHPM?

  • Rising out-of-pocket expenditure (OOPE) of the citizens is a key concern in the healthcare sector.
  • Among different sources of healthcare financing, 67% of the total health expenditure comes from households’ pockets.
  • Health expenses push about 7% of the population below the poverty threshold every year.
  • In this backdrop, the government launched the Ayushman Bharat-National Health Protection Mission (AB-NHPM) to reduce OOPE.

Is it a workable measure?

  • The AB-NHPM shares its objectives with the Rashtriya Swasthya Bima Yojana (RSBY) scheme.
  • RSBY sanctioned Rs 30,000 health insurance coverage per family per year for secondary and tertiary hospitalisation.
  • In the nearly 9 years of RSBY’s existence, the scheme objectives are yet to be met.
  • The quality of healthcare provisioned under the RSBY was compromised because of insufficient coverage.
  • In this respect, the Ayushman Bharat scheme is a positive step up, with an increased coverage limit of Rs 5 lakh.
  • However, some less-desired aspects of the RSBY are reflecting in the AB-NHPM scheme as well.
  • The capacity of increased coverage to reduce the actual OOPE is limited in the current form of this scheme.

What are the continuing concerns?

  • Coverage - Despite the increase in coverage amount, the AB-NHPM is limited to only inpatient care.
  • The Rs 5 lakh cover is intended for secondary and tertiary care ‘hospitalisation’ only.
  • The outpatient expenditure, which forms a major part of OOPE, has been left out of the ambit of the AB-NHPM.
  • Poorer people, functioning on daily income, tend to avoid hospitalisation due to the associated loss in working income.
  • Therefore, outpatient care inclusive of diagnostics and medicines needs to be insured for them.
  • Private players - Private sector participation in healthcare services has been increasing at a quick rate in urban areas, while remaining more or less constant in rural areas.
  • In 2014-15, over 68% of hospitalised cases in urban areas, and 42% in rural areas, got recorded in private hospitals.
  • Even in top-performing states with the highest government health expenditure, the spending in private sector in OOPE form is quite high.
  • But the scheme, in its current form, may not be able to account for this rising private players' participation.
  • The increase in compensation under AB-NHPM holds value only when it is able to induce insurance coverage for healthcare services provided by the private sector.
  • The list of hospitals empanelled under the scheme does contain many private hospitals.
  • But under the single rate card provision of the scheme, the private sector’s willing participation seems unlikely.
  • This is because the prices proposed under the rate card fall much below the expectations of private sector healthcare providers.
  • Medical packages list - Preparing the entire medical procedure list at the central level is a potentially suboptimal move.
  • This is a challenge given the heterogeneity in healthcare needs and disease prevalence across the country.
  • A study under the India State-Level Disease Burden Initiative highlights the need for state-specific health interventions.
  • There are comprehensive inequalities in disease burden and its causes across states.
  • So there is a deep-rooted need for disease-specific interventions, with specialised attention to associated risk factors.

What is to be done?

  • Cooperative federalism can go a long way in addressing the above challenges.
  • States’ role needs to be enhanced at planning stages, a shift from their current role as implementers.
  • E.g. states could be given the responsibility of preparing the medical package list
  • This will encourage cost-effective accounting for inter-state variation.
  • Also, if poorer states could set up lucrative prices for healthcare packages, it could augment private investment in these states.
  • So, while the objective of the scheme is welcome, the implementation challenges deserve some serious thought.
  • Increased states’ participation and inflation-adjusted rates for procedures could help India progress towards its universal healthcare goal.

 

Source: Financial Express

Login or Register to Post Comments
There are no reviews yet. Be the first one to review.

ARCHIVES

MONTH/YEARWISE ARCHIVES

Free UPSC Interview Guidance Programme