Ayushman Bharat or the National Health Protection Scheme can prove a game changer in the health sector of India, entailing welfare as well as market competition, provided the state can meet the challenges of logistics, manpower and corporate hospitals’ greed
With several interviews with the media, Finance Minister Arun Jaitley, Finance Secretary Hasmukh Adhia and quite a few senior government officers are presenting a clearer picture of the recently announced Ayushman Bharat or National Health Protection Scheme or upwardly revised UPA-era Rashtriya Swasthya Bima Yojana. A cynical rejection of Prime Minister Narendra Modi’s ambitious project was expected from the announcement of a fund of a mere Rs 2,000 crore, not enough to cover the premiums for a Rs 5 lakh cover per person a year, but some private insurers reacting positively to Jaitley’s Budget speech on the very first day gave an indication this would not be a typically socialist, rob-Peter-to-pay-Paul programme. Those not from the political opposition had no doubt the declared amount was just a statement of intent, and that sponsoring the poor and the vulnerable would not be an issue. It is so transpiring that, while the Centre will share 60% of the burden and the State will pay the rest, the pool — to be managed by a coordinating trust or society — will include some money of interested private insurers. As the earlier state medical insurances could not achieve the target of providing a cover of up to Rs 1,00,000 a patient, and could manage at the most Rs 30,000 per individual claimant, the participation of the private sector for the capital investment assumes significance. Data have shown that many in the lower middle income group slumped to the economic status of the poor owing to the cost of the regular treatment that their chronic ailments demanded, for which the state cover proved inadequate. This limitation is another reason why the States should not nitpick over the choice between their existing blueprints and that newly suggested by the Union. They ought to readily allow their schemes to get subsumed in the larger central system.
On the business side, the players interested wouldn’t complain because, as is well known, from the total collection of premiums for any kind of insurance, just a small section of customers claim the amount before maturity. Further, a medical insurance, unlike a life insurance, is a better deal for the company because it does not have to return all the money collected to the insured — let alone with interest — if the latter does not claim the cover within the stipulated time. It’s good market economics, too; those who are already consumers of private medical claims now have a reference point in the form of the state scheme. All insurers will, therefore, be under pressure to offer better terms to the people. But if private practitioners are upbeat too, the state must ensure that widespread insurance does not make nursing homes go for the kill while billing the patients.
Mexico has seen that a universal healthcare programme takes more than money. The designated health centres the people are asked to visit to avail the offer need enough trained personnel as well as the medicines prescribed. The state medical apparatus and service experienced so far does not inspire public confidence, and this will prove the weakest point in implementation of Ayushman Bharat, the world’s largest state-sponsored health insurance plan. What all diseases will be covered is not much of a concern though; a state scheme will definitely have a scope larger than those of its private counterparts. A list of the urgent medical requirements most insurers do not address can be easily made and added to the Ayushman Bharat menu. The migration of Americans southward for affordable healthcare suggests a future scenario where India’s doctors will attract medical tourists for this reason as well. In the cascading effect, if the manpower and logistical challenges are met well, every Indian will be insured medically for a price that wouldn’t claim his life.