Increased access to care: lessons from the Ayushman Bharat Program

This week the Union health minister Mansukh Mandaviya stated that “Teleconsultation is the future of our healthcare system, and we should work towards promoting it on a large scale as it provides a perfect platform to provide health services to the last mile”

This comment came during his address to the Central Council of Health and Family Welfare, in Gujrat. It is interesting that the minister is talking about a system that was illegal and punishable by law till 25th March 2020 and the only reason that the guidelines were allowed for Teleconsultation was because of the Novo Coronavirus or Covid19 Pandemic.

This goes on to show how far we have come in the last 2 years, with growth in many areas due to the digital transformation that is happening across industries. While eCommerce and retail have immensely benefitted, the advantages to healthcare have been immeasurable.

This month I had the opportunity to attend the Philips Health conference where the focus was on access to care and leveraging programs like Ayushman Bharat and Technology for the same.

While programs like Ayushman Bharat under the Pradhan Mantri Jan Arogya Yojana (PM-JAY), which is essentially a Healthcare Assurance scheme have already created records of sorts by empowering 500 million Indians below the poverty line up to 500,000 rupees for treatment. As of March, almost 31 million citizens have been treated under the program, the rise in public health programs like wellness centers would provide a further boost to the growth in healthcare.

Ayushman Bharat has benefitted both public and private hospital setups, with both private setups, primary health centers, teaching hospitals, and district hospitals along with government hospitals participating in the program. The focus has been on increasing seamless access. In certain states like Karnataka, where already the Yeshasvini Program was running since 2002, there have been some delays because of the distribution of the eligibility cards. The earlier program was focused on cardiology with the scheme open to members of cooperative societies who needed to pay a minimum premium to be eligible for the scheme. In addition, now there is a move to integrate the wellness centers, to the tune of 80,000 PHCs that will double up as wellness centers and work more on the prevention. I had written about it some time ago on the need to have wellness centers to support the in-patient admissions.

Healthcare programs are not new to India, having successfully eradicated Smallpox in the 70s and then going on to activate the nationwide Pulse Polio Program. But what makes Ayushman Bharat special is that it is a demand-side financing scheme. Most of the healthcare financing has been on the supply side, building more health centers, hospitals, labs, diagnostic centers, etc. But with Ayushman Baharat we have created the demand by financing the demand for health services. Is it estimated that almost 70% of Indian citizens are covered by some healthcare scheme with the likes of ESIC, CGHS, SGHS, Railways, Defense, and PSU schemes in addition to private insurance and Ayushman Bharat?

The government centers have specifically benefitted from Ayushman Bharat as they have no other sources of funds to improve their infrastructure. Today the old teaching colleges get almost 12% of the fees and 18% to the new medical colleges. In addition, 50% to PHCs and 30% to district hospitals. This is a very important source of funds that can really help improve the public health infrastructure of the country.

One area that is interesting is that almost 64% of the claims are coming from private sector hospitals in urban areas. All this while there has been no growth of the private sector in the various rural districts and taluks. While the scheme benefits rural India, the travel to urban centers for treatment has not diminished under this scheme.

Having said that there is still a hidden group of people who are above the poverty line and not in the higher quartile of people who have private insurance. I think the government understands this and in line they have opened the scheme to gig workers as well, those earning between 15000-25000 rupees a month. I don’t have all the details, but this looks like a step in the right direction.

I will take up the other aspect of access to care leveraging technology in a subsequent post.

Dr. Vikram Venkateswaran

Management Thinker, Marketer, Healthcare Professional Communicator and Ideation exponent

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