At the helm of affairs of the Pradhan Mantri Arogya Yojna, Dr Indu Bhushan, a bureaucrat-turned- economist, worked as senior economist with the World Bank Group and as Director General, East Asia Department of the Asian Development Bank (ADB) in his career spanning 35 years to provide oversight to a multitude of sectors like energy, environment, natural resources and agriculture, transport, public management, financial sector and regional cooperation, urban and social development.
The CEO of the Ayushman Bharat Mission told AJITA SINGH in an interview that it is a demand-driven and fund-driven scheme that focuses on empowering the poorest of the poor. Excerpts:
Q: What is Ayushman Bharat?
A: Ayushman Bharat Yojna, or Pradhan Mantri Jan Arogya Yojna is a centrally sponsored National Health Protection Scheme launched in 2018 under Ayushman Bharat Mission of Ministry of Health and Family Welfare. It aims to provide health benefits to over 10 crore families from urban and rural areas.
Q: What are the benefits of Ayushman Bharat?
A: It entails increased health benefit cover to nearly 40 per cent of the poor and vulnerable population covering almost all secondary and tertiary hospitalisation. The scheme includes an insurance cover of Rs 5 lakh to almost 50 crore citizens.
Q: Isn’t it like other any previous health scheme started by the government?
A: No. It involves a totally different approach. It is largely a demand-driven supply scheme of creating facilities and services to be used by people. It involves services to be provided by hospitals, doctors, nurses, paramedical staff, healthcare systems. Earlier, the assumption was that once you create an infrastructure everyone, including poor people, will directly benefit. But that assumption was not entirely correct. Because the poor people are usually less empowered and socially they face problems in seeking solutions to address their health problems. Also, the incentive to the healthcare givers in the system to provide services to the poor was not there. There was a question of inequity too. When we compare the healthcare seeking behaviour of poor people vs rich people, the poor use much less services.
Q: What is so special about the scheme this time?
A: So far, the major focus has been on government services. In private sector, there was not much support. Quality of services both in public as well as private sector was another important issue. There was no enforcement of quality, both in public and private sectors. Lots of efforts were made to improve the quality but still there was much left to be desired. This scheme, however, is very different. It is based on demand, i.e. it is demand-driven. It is about demand-side financing. Money will flow, that is funds will be provided only when a person (40 per cent of the poorest) will use the services, not otherwise contrary to the earlier situation where money was provided one time. Here what we mean is that the scheme is not merely for providing infrastructure and services but for the use of services ~ both in public as well as private services.
Q: According to you the poorest would get empowered. How?
A: This scheme is about empowering the poorest. As money is being given in the hands of these people, it is they who become the sought-after patients like the rich ones. Because now, they too would be paying for the services as the former.
Q: What would it mean for the healthcare providers?
A: Earlier, the services were to be provided free-of charge which was not sufficient motivation for the healthcare providers. The poorest people were a sort of a burden to the healthcare agents who used to treat these poor patients as if they were doing charity. But now, these healthcare seekers become much more ‘sought after’ patients in the system as they too come with money behind them. As the scheme is open to both public as well as private sector, the poor can also avail the facilities of private hospitals. Private sector can get empanelled for services.
Q: Doesn’t this scheme promote private sector?
A: We are not merely promoting the private sector, but are hoping that they would also shoulder the government’s responsibility. As we are engaging with private sector through money, we have a leverage. None of the earlier schemes had that kind of leverage. They were based on the article of faith that once we define the system, the private sector will follow suit. But now, we can ensure that they follow what we set as standards or define the system or lay the guidelines because now the private sector will get the money only if they provide what we have asked them to do. If they do not, then with audits we can enforce quality standards. Hence, this scheme is totally different in terms of targeting, in terms of participation of private sector and in terms of ensuring quality.
Q: What end-result do you expect?
A: Through the scheme, we will reduce the out-of-pocket catastrophic expenditure that poor people often face. It will also ensure quality services in poor areas, in rural areas near Tier II and Tier III cities. This is one of the mini schemes. We are hoping that it will be a catalyst in making the desired changes. Other efforts, however, to improve infrastructure will continue as much more infrastructure is needed. At present only 0.7 beds are available per 1000 population. Four times more are needed. So is the medical and nursing staff short on the supply side.
Q: What does a targeted beneficiary have to do to avail the facilities?
A: Firstly, they have to be part of the scheme. A list has been made using a database of 50 crore people on the basis of Socio Economic Caste Census (SECC) 2011. There are 6 to 7 deprivation categories for rural areas. It includes people living in one-room dwellings, landless labourers, etc. For urban areas, the list is made based on 17 to 18 occupational categories; like ragpickers, beggars, autorickshaw drivers, sanitation workers, cleaners, electricians, construction workers, etc. One has to see if one’s name is on the list. If it is there, then through Aadhaar we confirm the name and issue an E-card. Here SECC decides the eligibility and Aadhar authenticates the identity. With this E-card, these targeted beneficiaries can go to any of the 15,000 empanelled hospitals across the country for paperless, cashless treatment of any ailments of 1,400 identified health conditions. The support includes preadmission up to three days and post discharge up to 15 days.
Q: Has the scheme come into operation?
A: Yes. Over 13 lakh patients have already benefited. The government has so far spent about Rs 1,700 crore on the healthcare facilities under the scheme.
Q: Is this fund exclusive of the budget allocation for health?
A: It is a separate allocation, though part of the total health budget for the financial year 2019-20. By 2025, the government intends to double the health budget.
Q: What if the dispensation changes at the Centre?
A: Ayushman scheme is good on socioeconomic parameters and so good for people. What is good for people, is good for politics. Thus, hopefully it will continue to serve people irrespective of governments.