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Pradhan Mantri Jan Arogya Yojana- Ist Anniversary, Problems and solutions

Pradhan Mantri Jan Arogya Yojana- Ist Anniversary, Problems and solutions

Tag:GS 2||Governance & Social Justice|| Human Development|| Health

What is the issue?

  • Ayushman Bharat-Pradhan Mantri Jan Arogya Yojana which completed a year recorded 4 lakh hospital treatments worth Rs 7,500 crores with 60% of the amount being spent on tertiary care.
  • the tertiary care arm of Ayushman Bharat has funded the treatment of 90,000 cancer patients through 1.8 lakh hospital admissions.

PMJAY

  • The program is being touted as the world’s largest health protection scheme.
  • The scheme has two pillars under it –
    • Ayushman Bharat(AB) –  5 lakhs health sub-centers will be converted into health and wellness centers.
    • National Health Protection Mission(NHPM) – Provides health cover of 5 lakhs per family, per annum, reaching out to 50 crore beneficiaries.
  • The scheme aims to target over 10 crore families based on the SECC (Socio-Economic Caste Census) database.
  • It will target poor, deprived rural families and identified occupational category of urban workers’ families.
  • It will cover 1,300 illnesses, including serious ones such as cancer and heart diseases.
  • Private hospitals would also be part of the scheme.
  • To ensure that nobody from the vulnerable group is left out of the benefit cover, there will be no cap on family sizeand age in the scheme.

Facts

  • 5 million Cases: There were about 4.5 million casesof hospital treatment under the scheme, a large figure until the number of possible causes in the country is considered.
  • Public awareness and access: The relative smallness of this number points to an issue yet to be addressed
  • The PMJAY has spread across practically the entire country, with 33 states and Union territories.
  • Hold-outs: The only big hold-outs to the scheme are some of the Opposition-ruled states including Delhi, West Bengal, and Telangana.
  • Claims higher in richer states
    • The number of claims is considerably higher in the richer states like Gujarat (650,000) and Tamil Nadu (400,000).
    • Another million or so is accounted for by Karnataka, Andhra Pradesh, and Maharashtra.
    • As with many other all-India schemes, states with better resources are managing to implement it better.

Problems

  • Slow scale-up of the scheme: While the slow scale-up of the scheme is a problem, it does mean that its fiscal impact has not yet been felt fully.
  • Fiscal impact It is possible that the fear of the fiscal impact is why some poorer states have not expanded it as much as they should have. Fiscal impact refers to the impact on the state government’s  budget or financial resources of the state.
  • Cost controlis going to require more attention. This will necessarily widen the gap of fiscal deficit.
  • Package rates: The package rates for private providerswill be the cause of resistance in the future. The scheme is implemented through the existing mechanism, based on the  US model of healthcare insurance. The government does not provide free healthcare or doesn’t add on to the existing infrastructure but provides free healthcare insaurance, the public institutions or private institutions linked to the yojana will provide the healthcare facilities to the citizens.

Solution to the above problems

  • reduced costs The PMJAY authorities will have to take pro-active measures to reduce costs – Collective bargaining with pharmaceutical companies or the makers of medical equipment.
  • expansion in the number of private hospitals There may be a sharp expansion in the number of for-profit private hospitals impanelled under the scheme.
  • The current number of hospitals is only a whisker more than the number of public hospitals so registered.
  • There should be a clear understanding of package coststo pan this out as expected.
  • With the expansion of for-profit hospitals, questions will also begin to be asked about widespread fraud.
  • This was visible in the first year of the PMJAY, with an unnecessary increase in the rates of some treatments.
  • The PMJAY highlights its data-based interventionto identify such possibilities of fraud.
  • But in the end, disputes will have to be settled by old-fashioned human intervention.
  • There is simply no capacity yet planned for in the Union government or in the states to manage such disputes.

What is needed for the success of any model

  • The PMJAY has multiple different models in different states.
  • Expansion of state capacity The common requirement for the success of any of these models will be the expansion of state capacity, whether in terms of regulation, dispute settlement or in the public sector hospitals themselves.
  • It is impossible to build universal health care on the cheap. The PMJAY has so far not been a fiscal drain.
  • more resources, If it is to succeed, it will certainly require more resources, many of which will have to be diverted to support the poorer states.
  • Focus on poorer states:The implementation is better in richer states because of more financial resources, poorer states need to be focused so they could get access to the better healthcare facilities.

Conclusion

  • Ayushman Bharat has provided a platform and framework for the country to accelerate its progress towards comprehensive universal healthcare.
  • All states will need to make sincere efforts towards providing seamless health services to the last mile and to address the concerns, challenges, and hindrances on the way to reach the goal.

Mains question

  • PMJAY has a number of challenges to contend with as it seeks to improve the status of health care in India. Discuss.

References