Ayushman Bharat- PMJAY: Miles to Go

Building a strong delivery network, with wide participation by the private sector, is very critical for successful implementation of the scheme, says Dr. H Sudarshan Ballal

Ayushman Bharat, PMJAY, Dr H Sudarshan Ballal, Pradhan Mantri Jan Arogya Yojna, AB PMJAY, Government healthcare  scheme, Ranchi, Jharkhand, Ayushman Diwas, Broadly, NATHEALTH AAROGYA BHARAT REPORT, NATHealth, Healthcare sector, Sudarshan Ballal, Universal Health Coverage

Ayushman Bharat - Pradhan Mantri Jan Arogya Yojna (AB PMJAY) is the world’s largest government-supported healthcare scheme that aims to provide more than 10 crore poor and vulnerable families (or 50 crore individuals) with a health cover of Rs 5 lakh per family per year for secondary and tertiary care for a range of serious illnesses. AB PM-JAY was launched by the Honorable Prime Minister last year on September 23 from Ranchi, Jharkhand. India will be celebrating one year of successful implementation of the Yojna, the world’s largest government-run health insurance scheme as Ayushman Diwas. Broadly, Ayushman refers to longevity and healthy life. 

According to government data, more than 39 lakh people have availed free treatment under the scheme so far and this has resulted in savings of approximately Rs. 12,000 crores to the nation. According to NATHEALTH AAROGYA BHARAT REPORT, non-communicable diseases will cost India $6.2 trillion by 2030. Hence, our top priorities include increasing affordability through low-cost products and services, overcoming access barriers, and providing quality care. 

Building a strong delivery network, with wide participation by the private sector, is very critical for successful implementation of the scheme. The scheme also needs to focus on digital technologies which can act as great enabler. With digital, the sector will be able to manage fraud, waste and abuse efficiently. In a system, like Ayushman Bharat digital will play a big role along with Analytics in managing the right patients are given the right amount of care and there is no misuse of the scheme.

For a larger and meaningful impact, it is critical to adopt a partnership approach between Ayushman Bharat and the private sector. The focus needs to be on the point that health services delivered to the beneficiaries are safe, sustainable and of appropriate quality to ensure people-centric care. All efforts should be made to strengthen and reinforce the primacy of an effective and viable delivery ecosystem.

As a collaborative and inclusive healthcare industry body- NATHEALTH has collaborated with the nodal agency NHA not only for arriving at a rational and sustainable price package of the procedures under the Yojna but also driving the scheme through innovations. Collaboration on these two critical points- Pricing and innovations, is an important step to work out a robust mechanism that draws upon the expertise available across the healthcare sector to achieve universal health coverage in India.

Going forward, the healthcare sector needs to focus on the exercise of calibrating package rates and the development of standard treatment protocols to ensure quality healthcare across India. For the long term success and sustainability, big and specialty hospitals need to be on board and for that, a new model with rational pricing has to be in place. We need to establish a transparent process based on established methodology and global best practices. It can be done with inputs and full involvement of the private sector in the costing process.
We have miles to go to create awareness about the scheme. A massive campaign is needed to make people aware of the scheme. It is very encouraging to note that the healthcare sector and the government agencies observe September as 'Ayushman Bharat Diwas' to generate awareness about the scheme. As India moves towards Universal Health Coverage (UHC), there has to be a collaboration between payers and providers to ensure quality and accountability on one side and to ensure the sustainability of provider enterprises through realistic pricing mechanism through scientific costing on another side.

As India drives towards making healthcare more accessible, affordable and inclusive, quality should be front and center in policy discourse.

Dr H Sudarshan Ballal is  President of NATHEALTH.