Insights into Editorial: The primary anchor of a health-care road map
Prime Minister Narendra Modi rolled out the Centre’s flagship scheme Pradhan Mantri Jan Arogya Abhiyaan, also known as Ayushman Bharat or the National Health Protection Mission (AB-NHPM).
This is the world’s largest health scheme which will serve a population that equals 27-28 European countries. The beneficiaries are almost equal to the population of Canada, Mexico and US put together.
The Prime Minister also launched a toll free number 14555 for people to get more information about Ayushma Bharat scheme.
Achieving Universal Health Coverage:
Universal health coverage is getting prioritised as a part of political reform with the launch of two pillars of the Pradhan Mantri Jan Arogya Yojana (PMJAY):
- Ayushman Bharat (AB), where 1.5 lakh health sub-centres are being converted into health and wellness centres.
- The National Health Protection Mission (NHPM), which aims to provide health cover of ₹5 lakh per family, per annum, reaching out to 500 million people.
Align Health entitlement to Income lines: Health Premium subsidy in line with housing categories:
This 2003 solution of the Vajpayee-era recommended, inter alia, that good governance lies in aligning the income lines for health and housing.
In other words, de-link entitlement to health care from the poverty line.
In that event, the income lines for housing could be simultaneously applicable for health entitlement. The PMJAY would help improve availability, accessibility, and affordability for the needy 40% of the population.
The government could then proceed, to scale the health premium subsidy in line with housing categories — economically weaker sections (entitled to 75-90%), lower income (entitled to 50%), and middle income groups (entitled to 20%).
Build in accountability for Cost and Quality:
The NHPM is pushing for hospitalisation at secondary- and tertiary-level private hospitals, while disregarding the need for eligible households to first access primary care, prior to becoming ‘a case for acute care’.
Without the stepping stone of primary health care, direct hospitalisation is a high-cost solution. Forward movement is feasible only through partnerships and coalitions with private sector providers.
These partnerships are credible only if made accountable. The National Health Policy 2017 proposed “strategic purchasing” of services from secondary and tertiary hospitals for a fee.
Upgrading district hospitals to government medical colleges and teaching hospitals will enhance capacities at the district level.
Service providers will become accountable for cost and quality if they are bound to the nuts and bolts of good governance outlined above.
Transform primary care to avoid Catastrophic Health Expenditures:
Third, elimination of catastrophic health expenditures for the consumer can come about only if there is sustained effort to modernise and transform the primary care space.
Bring together all relevant inter-sectoral action linking health and development so as to universalise the availability of clean drinking water, sanitation, garbage disposal, waste management, food security, nutrition and vector control. The Swachh Bharat programme must be incorporated in the PMJAY.
These steps put together will reduce the disease burden.
For Instance, Kerala and Tamil Nadu have demonstrated that high-performing, primary health-care systems do address a majority of community/individual health needs.
The health and wellness clinics must connect with early detection and treatment.
Robust delivery of preventive, clinical and diagnostic health-care services will result in early detection of cancers, diabetes and chronic conditions, mostly needing long-term treatment and home care.
Investment in primary care would very quickly reduce the overall cost of health care for the state and for the consumer.
At the 1.5 lakh ‘health and wellness clinics’, register households to provide them access to district-specific, evidence-based, integrated packages of community, primary preventive and promotive health care.
The “best health care at the lowest possible cost” should be:
- Inclusive by covering various sections of population;
- Make health-care providers accountable for cost and quality;
- Achieve a reduction in disease burden, and
- Eliminate catastrophic health expenditures for the consumer.
In addition to above, it should be accompanied by the nuts and bolts of good governance that will support solutions and systems to achieve these objectives.
Technology and innovation are further reducing costs. AI-powered mobile applications will soon provide high-quality, low-cost, patient-centric, smart wellness solutions.
The scaleable and inter-operable IT platform being readied for the Ayushman Bharat is encouraging.
Though the scheme looks optimistic, healthcare experts indicate that nationally mandating a health insurance system needs to improve the quality of government infrastructure pan India and offer better opportunities for the private sector at a right price.
The central government is trying to align with state governments and woo private players.
The PMJAY is trying to create a major shift in reshaping the horizon of public healthcare space, but the proof of its success lies in its implementation.
As we integrate prevention, detection and treatment of ill-health, the PMJAY will win hearts if people receive a well-governed ‘Health for All’ scheme.