Relevance: GS-2: Issues relating to the development and management of Social Sector/Services relating to Health, Education, Human Resources.

Key Phrases: Ayushman Bharat program, Out-Of-Pocket Expenditure, Curative and Preventive Healthcare, Secondary and Tertiary Care Treatment, National Health Authority, Health and Wellness Centres, Socio Economic and Caste Census, CMIE, Fake Medical Bills, Lack of Uniformity.

Why in News?

• Poor households in States that have implemented the scheme have seen significant reduction in out of pocket expenses.

Context:

• The recent Assembly election results have sparked a fresh round of discussion about the socio-economic impact of the social sector schemes launched by the Central government. One such scheme is the national-level health insurance scheme popularly known as the Ayushman Bharat.
• A recent working paper, shows that apart from other benefits, the implementation of the Ayushman Bharat program is associated with a 21 per cent decline in out of pocket health expenditure and an 8 per cent reduction in the tendency to borrow emergency loans for health purposes, among poor households.
• A large number of beneficiary households using health insurance instead of borrowing when faced with health emergencies and consequently experiencing a reduction in out-of-pocket expenditure relating to health insurance credibly indicate the effective programme implementation.
• Ayushman Bharat program , is a flagship scheme of Government of India to provide cashless secondary and tertiary care treatment from the empanelled public and private hospitals providing coverage to more than 10 crore poor and vulnerable beneficiary families.
• National Health Authority (NHA) is the apex body responsible for the implementation of Ayushman Bharat PM-JAY.
• It has two components:
  • Pradhan Mantri Jan Arogya Yojana (PM-JAY), earlier known as the National Health Protection Scheme (NHPS).
  • Health and Wellness Centres (HWCs).

Features of Ayushman Bharat program:

• Providing health coverage for 10 crores households or 50 crores Indians.
• Providing a cover of ₹5 lakh (US$7,000) per family per year for medical treatment in empaneled hospitals, both public and private.
• Offering cashless payment and paperless recordkeeping through the hospital or doctor’s office.
• Using criteria from the Socio Economic and Caste Census 2011 to determine eligibility for benefits.
• No restriction on family size, age or gender; all previous medical conditions are covered under the scheme.
• It covers 3 days of pre-hospitalisation and 15 days of post-hospitalisation, including diagnostic care and expenses on medicines.
• The scheme is portable and a beneficiary can avail medical treatment at any PM-JAY empanelled hospital outside their state and anywhere in the country.

A Study on The Outcome of Ayushman Bharat Program:

• Household survey data provided by the Center For Monitoring Indian Economy (CMIE) is used in this study. The survey asks households about their income, sources of income, expenditure, break up of expenditure, among other things. The survey also records the health-related out-of-pocket spending.
• In addition, the CMIE conducts three waves of surveys in a year wherein they ask the households about health-related indebtedness. This survey records whether a household has borrowed for health purposes during the survey period of four months.
• Although the programme was launched in 2018, it took some time to do the groundwork such as empanelment of hospitals, the issue of health cards, the spread of information, etc. Therefore, the survey round ending April 2019 (starting December 2018) is the first complete survey after Ayushman Bharat was implemented. The study period ends in March 2020 to avoid the impact of the ongoing pandemic confounding the results.
• Districts in the sample that implemented Ayushman Bharat, households that are eligible for Ayushman Bharat and fall in the bottom 10 per cent of the income distribution experienced a reduction in out-of-pocket expenditure on health by about 1 per cent after the implementation of the programme.
• Interestingly, in a sample of similar households belonging to the adjoining districts that belong to States that did not implement Ayushman Bharat, there is a 20 per cent plus increase in out-of-pocket expenditure on health.
• Given the unlikely possibility of neighbouring districts systematically differing in terms of health shocks, it is reasonable to conclude that the programme caused a 21 per cent reduction in out-of-pocket health expenditure within two years of its implementation.

Challenges Faced by Ayushman Bharat Program:

• A major challenge of implementing a national health care scheme would be starting with infrastructure in need of development to be part of a modern national system.
• India still has some basic healthcare challenges including relatively few doctors, more cases of infectious disease, and a national budget with a comparatively low central government investment in health care.
• While government hospitals have joined the program, many private corporate hospitals have not. The private hospitals report that they would be unable to offer their special services at the government low price, even with a government subsidy.
• There have been media reports of misuse of the Ayushman Bharat scheme by unscrupulous private hospitals through submission of fake medical bills. AB-PMJAY involves a robust information technology infrastructure overseeing transactions and locating suspicious surges across the country.
• There exist some challenges such as lack of uniformity of hospital procedures and protocols for doctors.

Way Forward:

• Ayushman Bharat has the potential to bring a tremendous positive change in not only addressing the affordability of medical procedures but also as a concomitant in the development of medical infrastructure.
• Appropriate measures will have to be taken to manage leakages for the scheme to succeed and not exceed cost projections.
• The results of study suggest that the Ayushman Bharat programme is achieving its primary purpose in the short run. It remains to be seen whether the programme leads to a significant improvement in human capital in the long run.

Source: The Hindu

Mains Question:

Q. “Ayushman Bharat – Pradhan Mantri Jan Arogya Yojana (PM-JAY) has led to a significant improvement in human capital in the long run.” Comment. (250words).