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Concerns in Ayushman Bharat

Concerns in Ayushman Bharat

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  • GS 2 || Governance || Human Development || Health

 Why in News?

  • The Ayushman Bharat-National Health Protection Mission (AB-NHPM) needs a relook, given the implementation concerns with it.

 Basics – Ayushman Bharat-National Health Protection Mission

  • The Ayushman Bharat -National Health Protection Mission (AB-NHPM) was announced in the Budget-2018. This scheme has two components: (1) Health and Wellness Centers. (2) National Health Assurance Scheme is known as Pradhan Mantri Jan Arogya Yojana (PMJAY).
  • Ayushman Bharat is an initiative to Address Health Holistically in Primary, secondary and Tertiary care Systems covering both Prevention and Health Promotion. The Scheme aims to provide cashless benefits of 5 Lakhs to 10 Crore Poor Families in the Country.

 Why AB-NHPM?

  • Rising out-of-pocket expenditure (OOPE) of the citizens is a key concern in the healthcare sector.
  • Among different sources of healthcare financing, 67% of the total health expenditure comes from households’ pockets.
  • Health expenses push about 7% of the population below the poverty threshold every year.
  • In this backdrop, the government launched the Ayushman Bharat-National Health Protection Mission (AB-NHPM) to reduce
  • Here Rs. 5 Lakh medical insurance per family per year.
  • All age groups and occupation groups covered. ESIC’s schemes cover only workers and their families (NOT FARMERS), Senior Citizen Health Insurance Scheme (SCHIS) covers only senior citizens (NOT INFANTS)
  • Cashless paperless treatment in secondary- and tertiary-care hospitalisation both in public and private hospitals.
  • Both pre and post-hospitalisation expenses, Transportation cost is also provided.

 Workable measure?

  • The AB-NHPM shares its objectives with the Rashtriya Swasthya Bima Yojana (RSBY) scheme.
  • The capacity of increased coverage to reduce the actual OOPE is limited in the current form of this scheme.

 Criticism of Ayushman Bharat

  • Currently, the NHPM is pushing for hospitalisation at secondary, and at tertiary-level private hospitals, while disregarding the need for eligible households to first access primary care, prior to becoming ‘a case for acute care’.
  • It is important to note that without the stepping stone of primary health care, direct hospitalisation is a high-cost solution.

 Ground reality

  • India ranks as low as 145th among 195 countries in healthcare quality and accessibility, behind even Bangladesh and Sri Lanka.
  • The country spends an abysmal 1.3 per cent of its GDP on health, way less than the global average of 6 per cent.
  • Over 70 per cent of the total health care expenditure is accounted for by the private sector. Given the country’s crumbling public health care infrastructure, most patients are forced to go to private clinics and hospitals.
  • Health care bills are the single biggest cause of debt in India, with 39 million people being forced into poverty every year.

 Way forward

  • Cooperative federalism
  • Increased states’ participation and inflation-adjusted rates for procedures could help India progress towards its universal health care goal.
  • Providing insurance covers alone will not improve the health system in the country.
  • Rather, there is a need to build robust health care infrastructure in the remotest corners of the country where people have easy access.
  • Budget allocation needs to be increased to realize the purpose of the scheme.
  • The health and wellness clinics must connect with early detection and treatment.

 Additional Info- National Health Agency (NHA)

  • National Health Agency (NHA) For focused approach and effective implementation of PM-JAY, an autonomous entity, the National Health Agency (NHA) was constituted. Established as a Society on 11th May 2018, the National Health Agency is registered under the Society Registration Act, 1860.
  • The State Governments are expected to similarly set up State Health Agencies (SHA) to implement PM-JAY.
  • The National Health Agency (NHA) will provide overall vision and stewardship for design, rollout, implementation and management of Pradhan Mantri Jan Arogya Yojana (PM-JAY) in alliance with state governments.
  • Inter-alia, this will include, formulation of PM-JAY policies, development of operational guidelines, implementation mechanisms, coordination with state governments, monitoring and oversight of PM-JAY amongst others.
  • The National Health Agency will play a critical role in fostering linkages as well as convergence of PM-JAY with health and related programs of the Central and State Governments, including but not limited to Ayushman Bharat – Comprehensive Primary Health Care, the National Health Mission, RSBY to name a few.

 Mains Question

  • What are the challenges in the Ayushman Bharat.