Ayushman Bharat – Not a healer for healthcare

#Ayushman Bharat (AB-PMJAY) touted as one of the largest government-funded #healthcare programmes, has been the talk of the industry since its inception. Completing 100 days in January this year the scheme claims to have provided 6.85 lakh patients – beneficiaries identified through Central Socio-Economic Caste #Census - hospital treatment while 5.1 lakh claims have availed of the scheme for which payment has been released. And none of the patients had to pay. However it looks glorious on paper is undistinguished on grounds. 

We rank as low as 145th among 195 countries when it comes to healthcare quality and accessibility, even behind #Bangladesh and #Sri #Lanka. We spend way less than the global average of 6%. The country’s healthcare infrastructure is crumbling; healthcare out of pocket expenditures are among the most significant causes for pushing nearly 39 million people into poverty every year. Can the scheme change this scenario?

On the government’s end, it would have been better if they had ironed-out the rules governing the interference between the two treatment sectors (public & private) before the launch of Ayushman Bharat. The reimbursement rates allocated by the government under the scheme are as low as 15-20% of the actual costs of surgeries and procedures. As per government pricing, Rs 5,000 is given for one session of chemotherapy for a cancer patient, which would lead to the usage of cheap drugs. Chemotherapy cost is otherwise close to Rs 15,000. The rates offered are unrealistic and sans overhead expenditures. It seems like the government is funding itself to do its work. There is a delayed cycle of payments that takes anywhere between six months to nearly one year under the Central Government Health Scheme (#CGHS). The government should ensure that the payments are received within 15 days of the treatment done. Hence, it appears hugely challenging for private players. There is always a cost to the low-cost treatment which can lead to the destruction of value-based medicine.

Instead of depending upon the insurance model the scheme would have been more effective in providing a more comprehensive healthcare delivery system. The inadequate allocation is not only insufficient but also a blow to the #Universal #Health Care (UHC). It seems like that the UHC has lost itself in the dim of the scheme. The government emphasizing on prophylactic aspects of healthcare for serviceable UHC should have started with primary healthcare centers.

The leaders of the country should realize that rather than experimenting with insurance-based models which have failed in the past, they should look at increasing spending on healthcare and make it the sole responsibility of the state. They have learned no lessons from the Rashtriya Swastha Bima Yojana (#RSBY) which is not different from the Ayushman Bharat scheme.