While most states have rolled out the scheme, the five states of Delhi, Kerala, Odisha, Punjab, and Telangana have opted out citing reasons such as funding and coverage apart from similar existent schemes.
Current State of Healthcare in India
The National Sample Survey Office (NSSO), in a 2014 report, revealed that a whopping 85.9% of rural households and 82% of urban households did not have healthcare insurance.
Further, ~24% of rural households and ~18% of urban households were forced to borrow money for meeting healthcare expenses in the past. Sadly, one-third of the deaths in India are due to the lack of medical attention. These dismal statistics paint a sorry picture of India's crippled healthcare landscape. Prime Minister Narendra Modi's PMJAY is expected to alleviate this situation.
Regarded as the NDA's flagship scheme, it has popularly come to be known as “Modicare,” analogous to Obamacare in the US.
So, who is eligible? Which facilities will be covered? Will it be a success? Here’s everything you need to know about it.
The scheme, which will provide a coverage of up to Rs5 lakh aims to benefit ~10cr poor and deprived families in rural and urban areas, i.e. ~50cr people (as per Socio Economic Caste Census survey). There is no upper limit on the size of family nor is there an upper age limit. This is to ensure that the scheme covers everyone who is in need. Every person listed in the Socio Economic Caste Census (SECC) database will automatically be enrolled in the scheme.
The scheme will ensure cashless coverage to beneficiaries who can, in turn, avail the benefits at government and listed private hospitals.
The scheme will be free for beneficiaries. However, it will cost the exchequer ~Rs 5,000cr this year and may double as it is launched across the country by 2020.
Union Home Minister Rajnath Singh said, “Now, the poor will not have to beg for the treatment of their family members. The scheme will also create employment opportunities. The Centre has also decided to constitute a national digital health authority and will spend 2.5% of GDP on the health sector."
As grand as it sounds, as with all welfare schemes in the country, this one won’t be very easy to implement. What are the key challenges the current government faces with respect to PMJAY? Let us find out.
Lack of infrastructure: More than 70% of Indian healthcare is concentrated in the private sector. The state simply lacks the massive infra required to cover such a huge population. The current machinery is definitely insufficient and results in long queues and delays in cases requiring immediate medical attention.
Shortage of personnel: There has been a constant shortage of healthcare personnel in the public sector. However, Modicare plans to open new hospitals in tier-2 and tier-3 cities and create job opportunities through the programme. Schemes such as Skills India may equip individuals to take advantage of these opportunities.
Timely funding: Timely funding to hospitals will be necessary to make the programme run like a well-oiled machine. However, lack of timely assistance from the Centre will once again result in a broken system.
Service quality: Dearth of infra and personnel may also lead to service quality issues, at least in the early days. To ensure that PMJAY is not the same as the old school model of government-run healthcare schemes, there will have to be a serious focus on quality.
Modicare, if implemented right, can revolutionize the quality of state-run healthcare in the country. Access and service quality will remain key to the success of the scheme. Further, if implemented as planned, it will be another feather in NDA’s hat to flaunt during the 2019 Lok Sabha elections.
Ayushman Bharat provides a comprehensive cover minus the non-payables and exclusions in traditional health insurance. It does not discriminate on the basis of age and preexisting conditions. Further, given the population under coverage, healthcare pricing will become competitive and affordable. Insurers may also benefit via cross-selling and increased awareness.
If all things go well, and with the right intent and effort, Ayushman Bharat can change the very fabric of India’s broken healthcare system.