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Ayushman Bharat bolstering access to healthcare services in India

Aseem Garg
Wednesday, September 7, 2022, 08:00 Hrs  [IST]

Access to healthcare has always been a point of contention between the common man and policymakers in India. The country has a categorically low budget allocation for healthcare, consistently to the tune of a mere 1-2 per cent. Exacerbating the issue, the rising population and increasing poverty have led to India becoming the disease capital of the world. The situation continues to deteriorate as the balance between the number of people looking for healthcare and the available healthcare resources runs askew.

As per a report published in the Lancet, India ranks 145th of 195 countries in terms of quality and accessibility of healthcare, trailing behind neighboring regions of Sri Lanka, Bangladesh, and Bhutan. While a lack of timely diagnoses play a huge role in India falling behind in the global healthcare ecosystem, the bulk of the problem lies in the lack of doctors and clinics throughout the subcontinent, which also directly impacts the cost of healthcare, which continues to climb upward reaching inaccessible levels.

It is not surprising, then, that India has a fast-growing disease burden that outpaces several nations while its access to healthcare lags other middle- and low-income economies. This is especially true for non-communicable and lifestyle diseases such as diabetes, kidney disease, and hypertension, among others. Although studies find that lifestyle ailments are the biggest killers in India, access to treatment to such diseases continues to be insufficient.

For instance, deaths due to kidney failure are greater in India to other low- and middle-income regions with the proportion of kidney failure patients with access to treatment lower than China, which is more populous than India. The issue of accessibility extends to other lifestyle diseases as well, owing to the fact that a majority of treatment centers and high-quality doctors exist in the country’s urban centers and are out of reach for a major chunk of the country’s population that resides in rural areas.

The result? Lifestyle diseases are increasing by the day while awareness levels and treatment options remaining stagnant. However, the government and key industry players have taken matters into their hands and are creating solutions to boost access to healthcare. Enter: The Ayushman Bharat Yojana. But, before delving deeper into this programme, let’s take a quick look at the healthcare system in India.

Decoding India’s healthcare structure
Having established that India’s disease burden is rising, it is crucial to understand how the burden in distributed across the length and breadth of the country. We have two sides of the same coin – public healthcare and private healthcare. On the private side, we have 43,486 private hospitals that house 1.18 million beds as of November 2020. The nuanced government side, on the other hand, has several rungs including the primary, secondary, and tertiary levels.

On the primary level - sub-centers and primary health centers are situated in extremely rural and semi-developed rural areas. On the secondary level, community health centers act as state-run facilities that offer a wider range of treatments including preventative healthcare. At the tertiary level, each district in the country has, or is supposed to have, a district hospital with 70-100 beds. Finally, we have medical research institutes like AIIMS that offer specialized facilities.

While the structure is nuanced, it is also problematic with several shortages. District and state level hospitals run by the government are painfully overloaded with patients with a severe shortage of staff, equipment, and other resources. On the other hand, while our private hospitals are equipped with state-of-the-art technology, they are exorbitantly expensive and out of the question for our growing middle-class population. Choosing between quality and affordability, patients and their families often receive diagnoses and treatments after it is already too late.

Ayushman Bharat was introduced to address this very conundrum.

Dissecting Ayushman Bharat Yojana
Also known as the Pradhan Mantri Jan Aarogya Yojana, the Ayushman Bharat Yojana was launched in 2018 with an aim to become the world’s largest health insurance plan. The scheme covers almost 50 crore beneficiaries across the country, offering a health insurance cover of 5 lakhs per eligible family. The scheme covers around 1,393 procedures. Including 3 days pre-hospitalization and 15 days post hospitalization including medicines and diagnostics. Eligible patients are also covered in terms of treatment costs, room charges, doctor’s fees, ICU, surgeon charges, and much more. It also covers pre-existing diseases and patients can seek treatment at any empaneled government or private hospital.

Another important benefit of the Ayushman Bharat Yojana is that it does not cap age, gender, family size, etc. The sum insured can be used by any member of the family.  Moreover, it offers cashless and paperless services, boosting inclusion for people living in the country’s hinterlands, outside the folds financial and healthcare insurance services.

While a thoroughly impressive scheme on paper with several benefits for rural India, the policy also has certain drawbacks that are quite prominent. Since the budget allocation towards healthcare is traditionally low, the Indian government has not been able to remove financial hardship from the lives of many patients in the country. The scheme itself has been rendered underfunded and, in many cases, has not been able to help reduce the out-of-pocket expenses for Indians.

The issue extends beyond the financial numbers. While the scheme covers 80-90 per cent of the most prominent diseases, 10 per cent still do not qualify under the well-intentioned Ayushman Bharat Yojana. The scheme excludes fertility treatments, organ transplants, cosmetic procedures, drug rehabilitation programmes, and most importantly, OPD procedures. The 75th NSO Health Survey found that number of patients who do not need is 135 times higher than those who do. This clearly denotes the need for OPD procedures to be included in the Ayushman Bharat Yojana or any scheme that caters to health insurance for rural regions.  

When the disease burden skyrocketed at an unprecedented pace during the Covid-19 catastrophe, it was seen that the number of patients treated under the Ayushman Bharat Yojana were low as compared to those eligible. In fact, while 78 lakh people needed hospitalization in March 2020 and December 2021, only 78 lakhs, or 11.9 per cent, were treated for free under the scheme. The underutilization was attributed largely to a lack of awareness about the scheme and public and private hospitals’ refusal to admit patients under the scheme during a time that saw rampant bed shortages.

The road ahead
It is said that medical expenses push 6 crore Indians towards poverty every year. This statement and scenario must become a thing of the past. For people seeking access to quality healthcare at affordable prices, the Ayushman Bharat Yojana came in as a gamechanger. It had set out to give free healthcare to 40 per cent of India - a huge and ambitious goal. The programme is also set to transform current health centers, including sub-centers, to set up 1,50,000 health and wellness centers across the country. As the government looks at increasing the healthcare allotment and furthering the digital health mission in the near future, it is plain to see that the scheme can make a significant positive impact to the country’s healthcare system.

Ayushman Bharat does an impeccable job at understanding the roadblocks that financially weaker sections of the society face. It is a strong successor of the previous Rashtriya Swasthya Bima Yojana of 2008 and the Senior Citizen Health Insurance Scheme of 2016.  A critical review of Ayushman Bharat and tweaking of its policies to meet the evolving needs to Indians will make sure that no Indian has to compromise on their lifestyle to save their life. Synergies between State and Central governments will also be critical to the success of Ayushman Bharat since it is a national scheme means to empower state governments to offer better healthcare to citizens. Medtech companies, pharmaceutical businesses, digital healthcare device companies, and every other stakeholder of the medical ecosystem must also come together to support this ambitious scheme that seeks to uplift lives and lifestyles in the country.

Finally, the country would need an increased focus on high-quality education and upskilling/reskilling programmes to create a skilled healthcare workforce to make sure that every medical practitioner at every level of the healthcare system is offering the best-in-class treatment to patients. A better and more robust implementation plan for Ayushman Bharat will help India emerge from the clutches of lifestyle and other diseases through adequate treatment to become a nation of happy and healthy families.

(Author is founder and CEO of DCDC)


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