GSE Red's take on Ayushman Bharat

Prime Minister Narendra Modi launched PM Jan Arogya Yojana (PMJAY); Ayushman Bharat on September 23, which is said to be world's largest government-funded healthcare scheme. The scheme became operational from September 25 on the birth anniversary of Pandit Deendayal Upadhyay.

The scheme is targeted at poor, deprived rural families and identified occupational category of urban workers families. Every person listed in the Socio Economic Caste Census (SECC) 2011 database, i.e 8.03 crore families in rural and 2.33 crore in urban areas will be entitled to be covered under these scheme. It makes that approx. 10 crore families which would be around 50 crore Indians. The magnitude of the scheme can be gauged from the fact that more than 1,300 ailments will be covered under it, including heart diseases, kidney and liver disorders and diabetes.

The scheme basically provides a cashless cover of upto Rs 5 lakh per family per year without any premium. While the beneficiaries can avail benefits in both public and empanelled private facilities, the payment for treatment will be taken care by the insurance cover. The estimated cost of the premium would not exceed Rs 1,100 per family. So, cost for 10 crore families it would be around Rs 10 thousand crore, out of which, 60 percent will be borne by the Centre and the rest 40 percent by the state. According to NITI Aayog estimate, even if hospitalisation rate is doubled after the implementation of the scheme, the cost is not likely to exceed beyond Rs 20 thousand crore, which is quite reasonable and very much economically sustainable.

If we take a look, about 25 percent rural and 18 percent urban population sink into poverty due to medical emergencies which batter the finances of poor families. This is because India spends only 1.3 percent of its GDP on healthcare. Whereas China spends 2.45 percent while neighbours Sri Lanka, Malaysia and Thailand spend almost double the amount spent by India. Hence, it is imperative to increase our contribution towards healthcare and so, Ayushman Bharat is believed to play a big role in it.

Under this scheme, Government believes that both private and government hospitals can pitch in to provide better healthcare facilities to the people. Almost all government institutes are associated with the PM Jan Arogya Scheme which is a big strength for the government. However, Private hospitals must be encouraged to increase the no. of general wards and timely payment must be taken care of, which we think will make half the battle won. Though, the success of the scheme depends mainly on the Center-State coordination. There are few states who have still not accepted the Center’s proposal for the scheme, while some feel their state schemes are better that the one given by Center.

Also other challenges include, proper mechanism for the enrolment and payment, awareness among the people, timely payment to the insurers and mainly switching from low volume high margin pattern to high volume low margin. Overall we think, government’s focus should be on better delivery system, which will help meet all the mentioned challenges.

After all this, there is no doubt that the Ayushman Bharat will prove to be a game-changer in the lives of the millions of impoverished people. And will also be the largest successful healthcare scheme all over the world.