Context:

• The launch of Ayushman Bharat, a national health protection scheme (NHPS), in the last stretch of this government’s tenure comes as no surprise. 

Health policies have two objectives:

• to enhance the health of the population and
• reduce the financial risk for those accessing treatment.
• Success in the first is measured by a reduction in the disease burden and subsequent increase in people’s longevity. 
• Reduced spending or getting impoverished when seeking health-care measures the second.
• Since the health scheme seeks to address both these critical health goals, it is an important step forward.

Goals of equity, efficiency and quality

The scheme has two components:

• upgrading the 150,000 sub-centres (for a 5,000 population level) into wellness clinics that provide 12 sets of services; and
• providing health security to 40% of India’s population requiring hospitalisation for up to a sum assured of ₹5 lakh per year per family.
• If implemented as integral components of a strategy to improve the abysmal status of India’s health-care system, these initiatives can help achieve the goals of equity, efficiency and quality.

Key issues

An evidence-based strategy will need to address and resolve several key issues affecting the sector.

• The first is the massive shortages in the supply of services (human resources, hospitals and diagnostic centres in the private/public sector), made worse by grossly inequitable availability between and within States.
• Second, the strategy for negotiating/containing prices being charged for services needs to be spelt out.  ‘Rajiv Aarogyasri’, the health insurance programme in Andhra Pradesh. The rates here were not only incomparable but also did not reflect market prices of common procedures or treatment protocols to be followed by hospitals. The Aarogyasri scheme has only package rates, a procedure that all States have since followed as a model. Package rates are not a substitute for arriving at actuarial rating. In the absence of market intelligence, arbitrary pricing and unethical methods cannot be ruled out.
• Finally, the absence of primary care. The wellness clinic component is a step towards bridging that lacuna, but with no funding, the commitment is hollow. In the northern States there are hardly any sub-centres and primary health centres are practically non-existent. 

Conclusion:

• In an environment of scarce resources, prioritisation of critical initiatives is vital to realising health goals. The implementation of Ayushman Bharat will have to be contextualised and synchronised with a reform agenda that must include improved governance and an enforcement of regulations.

Source:TH