Ayushman Bharat is arguably the largest public health initiative in the world and this is perhaps the right time to examine what we need to do to make the programme a success.

India’s annual health expenditure is just about 4 per cent of its GDP and almost 70 per cent of this is out-of-pocket expenses borne by individual people or their families. Consequently, millions of people every year slip into poverty because of catastrophic health expenditure, which is defined as 25 to 60 per cent of the annual household income of a family.

Health insurance, which is the solution to these problems, unfortunately covers just about 25 per cent of the total population. This includes publicly funded schemes such as Rashtriya Swasthya Bima Yojana (RSBY), similar schemes funded by several state governments, CGHS, etc.

Against this backdrop, Ayushman Bharat, with its plans to cover 100 million families across the country, appears like a breath of fresh air. The scheme has two main components: one that envisages the transformation of 1,50,000 primary healthcare centres and sub-centres into “wellness centres” that would lay stress on prevention of illness, and second, a health insurance package of ₹5 lakh for each of the 100 million families being covered. The latter would be publicly funded and would subsume the RSBY, which many believe has run its course over the past decade.

Implementation of the health insurance component will obviously involve the participation of many stakeholders, including state governments that run their own health insurance schemes, hospitals and healthcare providers, suppliers of medicines, medical gadgets, training institutions for doctors, nurses and allied healthcare personnel and, finally, the private health insurance companies.

Uniform treatment packages

A crucial aspect of any health insurance scheme is uniformity of treatment packages across the country, without which miscalculations of premiums and payouts may happen. Health insurance companies, both private and public, have faced resistance from the healthcare delivery industry in their efforts to standardise treatment costs. This could be attributed to also the lack of robust healthcare data. If the future needs to be different, one solution may be for the Central government to standardise treatment protocols.

The critical component of the success of Ayushman Bharat also lies in the negotiated healthcare costs. Firstly, central purchases of medicines, healthcare delivery, diagnostic services, etc., through tenders that have a minimum duration of five years are more sustainable. Secondly, keeping in mind the quality of medicines, purchasing should move from a volume (quantity)-based to value (quality plus quantity)-based process with the help of Health Technology Assessment protocols. Globally, the practice of value of medicine is being used extensively in health economics. This is another area in which India needs to mature.

And finally, the most important component is the health and wellness component. Experts have pointed out that upgradation of the primary health centres even in a phased manner would involve a huge up-front expenditure. But good quality primary healthcare invariably reduces the need for hospital admission and, in the long run, the overall healthcare cost. Poor quality of primary care services often forces people to postpone a health action such as a medical consultation, which sometimes reaches an emergency/tertiary medical condition.

Over the counter (OTC) medicines are a critical component in advancing consumer health because they allow people to treat or manage health conditions conveniently and successfully. In the absence of robust OTC guidelines in India, the NHPS (National Health Protection Scheme under Ayushman Bharat) should carefully consider reimbursement options and ensure that OTC medicines are not reimbursed and thereby proportionately using healthcare funding that is better employed in treating more serious conditions.

For Ayushman Bharat to succeed, the focus must shift from curative to preventive care. The administration must pay adequate attention to this aspect. Ayushman Bharat is thus very clearly WIP (Work In Progress). The next few years will show whether it is a game changer for India or yet another chimera.

The writer is Director-General, Organisation of Pharmaceutical Producers of India (OPPI).

Views are personal

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