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World Health Day Special 2019: Success and Challenges of Ayushman Bharat

World Health Day 2019

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The world is celebrating World Health Day 2019 today. The theme of this year’s campaign is ‘Universal Health Coverage’.

On the occasion of World Health Day on 7th, April,  Dr. Indu Bhushan, CEO, Ayushman Bharat – Pradhan Mantri Jan Arogya Yojna (PM-JAY) in an exclusive interview with TheHealth.Today shared the success and challenges of PM-JAY.

Dr. Indu Bhushan, CEO, Ayushman Bharat – Pradhan Mantri Jan Arogya Yojna (PM-JAY)

Q.1 When we talk about Universal Health Coverage, what does it mean?

A. To a common man, UHC means having affordable health quality services which are accessible in three dimensions. All the three dimensions must work out together i.e. (i) Number of People Covered, (ii) Kind of services and (iii) Coverage amount. It is not only about the number of people covered under the program. Of course! 100 percent people should be covered through UHC. But what kind of services are covered is very important too.

Q 2. Does PM-JAY cover all three dimensions?

A. Whether we cover only inpatient or outpatient or certain packages or all packages or cover transplants of organs and dental? Usually, we tend to cover a core set of health conditions that we believe should be provided to all citizens. Right now, there is cap of insured amount. Whether, it should be unlimited is a question raised by many?

Ayusman Bharat has made a huge success in all three dimensions. We have increased the number of people touching more than 50 Cr including other services it is close to 80 Cr. Everyone should be included and we are working out on it. We are covering 1400 packages in terms of services. In terms of amount, 5 lakh per family per year is covered under the program.

Q 3. How is the progress of PM-JAY?

A. More than 18 lakh people have been benefited through the program. 1.05 lakh beneficiary e-cards have been generated. 14,102 hospitals have joined hands with us. Rajashtan has also become the part of it. They will start the implementation of our program soon. We are having discussions with all the states, who have not joined hands with us yet.

Q 4. What are your current challenges in achieving the ‘Health For All’?

A. We are a bit away in providing ‘Health For All’ scheme. We are continuously working on the objective to cover the remaining people. We have not covered OPDs and other health conditions yet. Though, core group of health conditions have been covered.

Most of the other countries faced the same challenges. In Vietnam and China they started such programs from the poorest. As, it is much easier and justified to start with the poor.

We also demand support from middle and higher class of this country. They should join this scheme. But they need to pay certain amount of premium. Those who can pay, should pay to make this scheme a nice compact package.

If we make it voluntary, only who likes the services will pay and the cost of services will be going up. This will be good package if we include everyone. In future, we are planning to include everyone with this scheme.

The probability of getting sick is always there. But young people have lower probability. If everyone participates in the scheme, It will be a nice healthy social compact. Where healthy people would be paying for unhealthy people. Rich people would be paying for poor people. Young people would be paying for older people.

Recent emerging challenge is the Fraud people are committing in the name of PM-JAY. We have taken down many websites and centers. They were indulged in impersonating PM-JAY. These were fake centres and clone websites. They lure people by promising to provide fake e-cards.

We also found some hospitals in Jharkhand, UP and Chhatisgarh who were converting OPD patients into inpatients for wrongful gains. Some hospitals have charged money from the patients who were covered under PM-JAY for cashless treatment. We have taken strong action against such hospitals and asked them to refund the amount to the patients.

Q 5. The per capita income ratio between poor and better-off states is 1:5. How you are going to make PM-JAY a success in poor states also?

A. There is a big problem with the amount of money we put for health. Which is almost among the lowest in the world. This needs to be increased.

Spending more money is needed. We are in conversation with experts in that case. Apart from this, the cost of health services is also going up. Diseases are moving from communicable to non-communicable. Non-communicable diseases are more expensive and stays for longer.

No doubt, our population is aging. Diseases related to elderly people are more expensive to treat. Technology is also taking a fast course. In some cases, tech is reducing the cost, but it is also increasing the cost of services.

Moreover, people have more expectations now. When income increases then consumption of health services get doubled. Under all this circumstances, one challenge will be that how to keep the cost for services low?

Q 6. How you are going to keep the cost low for the quality of services?

A. Collective bargaining is a good tool in that case. If an individual gets sick, (S)he has to go his own way in negotiation of price and quality of services. The cost is always higher when individual deals alone with such situation.

But we are bargaining services collectively. We have already decided the prices and putting it in pace as per the standard treatment protocol. It will help us reducing cost surely. Once scheme stabilises, we will be reducing the prices of devices, implants and drugs etc.

Q 7. Is health insurance a never-ending process in the absence of preventing primary health care services?

A. Primary health care is necessary. Many of diseases can be nipped in the bud. It will reduce the burden on our system. Cost of services will come down and will become more affordable. Undoubtedly, prevention is better than cure.

PM-JAY is strengthening primary health care indirectly. Health and wellness centre is a part of UHC. In primary healthcare, if one is getting screened and diagnosed with cancer, one needs an immediate treatment. Without the treatment support the screening and tests will not be enough for the sick. PM-JAY provides support of affordable treatment. It makes primary health care effective in that case.

But even if the primary health care is strengthened, still there will be people who will have cancer, heart diseases, would need knee/hip replacements. If they are poor people they can not afford the treatment for such ailments. PM-JAY is working in that direction to provide affordable quality of services in health

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