Governance Now Visionary Talks Series

Rethinking healthcare

Ayushman Bharat must be looked at not in isolation but as a major milestone among several steps taken towards building a sustainable health ecosystem

Vidushi Sahani | March 20, 2019


#Pradhan Mantri Jan Arogya Yojana   #NDA government   #healthcare   #Modi government   #PM Modi   #Ayushman Bharat   #PMJAY  


The new world is aggressively batting for individual rights and self-determination. As the society is evolving for the better, we see a more assertive Indian coming to the fore. An Indian who has higher expectations and an Indian who is cognizant of his/her rights. Our constitution guarantees us several freedoms and rights, with Article 21 affording a window for the generations to interpret and subsequently widen its ambit with scope and resources, rendering a more just and inclusive society. Today we find ourselves heading towards a new chapter, a social imperative astonishingly missing from national discourse until now – an equitable Right to Health. 

 
For decades, quality healthcare was luxury a major chunk our population could not afford. A brutal and unjust financial fencing made health a premium commodity. Ayushman Bharat seeks to rectify this huge anomaly which has been dragging 4.65 percent of our population below the poverty line because of catastrophic health expenses. Ayushman Bharat is a strategic move to improve the healthcare infrastructure through wellness centres being established across the nation on one hand and providing a coverage of Rs 5 lakh per family per year under Pradhan Mantri Jan Arogya Yojana (PMJAY), on the other. 
Launched on September 23, 2018, PMJAY is set to revolutionise the entire healthcare sector by bringing in a collaborative arrangement among stakeholders and maximising the benefits accrued to the common man. The scheme targets the poorest 10.47 crore households and seeks to eventually transform into a universal healthcare (UHC) for the nation. In its crucial first phase of implementation, we investigated the experiences of industry and the social impact on beneficiaries. The findings hint at massive social, economic and behavioural sectoral changes in the offing.
 
Fascinating insights into the impact of the scheme were came out when we spoke to the beneficiaries, how a government cover afforded them an opportunity to get treatment irrespective of severity of the disease or costs involved. Largely underserved in terms of health services, putting off or ignoring minor illnesses due to financial constraints has been a common practice. With PMJAY, the attitude is set to change. Most of the beneficiaries interviewed were not only getting health problems resolved on priority, they were now getting treatment for their ailments left unattended for decades. This behavioural change is likely to manifest itself in terms of better health status of people in the long term.
 
Along with this, a significant economic impact noticed was freedom from the cascading impact on people owing to catastrophic health expenses debilitating a family’s well being and stability. A significant number of beneficiaries interviewed had taken debt at some point of their lives to pay up hospital bills in the past, many people had been uprooted and had to move back to their villages or had to sell off their assets. Amongst all the negative impacts, children’s education turned out to be a major casualty. PMJAY, just four months into its operationalisation, is already addressing these serious concerns. The domino effects of Ayushman Bharat would become apparent with passage of time but the inklings of a positive change are perceptible nonetheless.
 
Interviews also pointed to another encouraging scenario where people are increasingly shifting from unverified treatment options or quacks to quality and certified healthcare providers. Several beneficiary interviews indicated that the first course of medical treatment was generally a neighbourhood clinic and with increasing severity of the ailment people generally turned to traditional or home remedies, instead of hospitalisation. Several cases came forth where people who had been on such a course, were now taking recourse at high-end empanelled healthcare providers.
 
Along with a significant impact on beneficiaries, the scheme is also giving a major thrust to private hospitals, especially in tier-2 and tier-3 cities. Instances came across where private hospitals were augmenting critical hospital infrastructure such as beds, diagnostic machines and technological upgradation. 
The scheme also stands strong on terms of monitoring and overcoming leakage probabilities. Robust software and accountability measures such as pre- and post-authorisation, along with uploading of pre- and post-surgery photographs and video-graphing of operative procedures have ensured transparency throughout the process.
 
The scheme is also a graduation over the existing fragmented approach to public health. It must be noted that several health sector policy interventions have laid the groundwork for an inclusive healthcare ecosystem, where PMJAY stands as a convergence point. A careful look at a few of the ‘focused and comprehensive’ schemes/policy decisions taken by the government such as drastic slashing of cardiac stents and knee implant prices, Poshan Abhiyan and E-Health, among others, affords an understanding that a strong and strategic foundation has been laid for culmination into the final goal of UHC. Ayushman Bharat, hence, must be looked at not in isolation, but as a major milestone among several steps taken towards building a sustainable health ecosystem.
 
Responses from PMJAY beneficiaries can be summed up into a range of emotions like hope, belief, gratitude, feeling of being valued, perception of policy fairness and self-dependence. I leave you with a thought-provoking story of Sant Prakash, whose account enables a clear distinction between what the healthcare scenario was and how things are drastically changing.
Sant Prakash, a 66-year-old truck driver from Haryana, recently underwent a heart surgery at a private hospital in Gurugram. We spoke to his son, the only earning member other than his father, in a family of six. Speaking with a veritable sense of calm and satisfaction, he said the expensive surgery would have been beyond the family budget, but for the PMJAY, as they were not even in a position to take debt. He recalled that just a year before PMJAY was introduced, he lost his mother to a chronic liver problem. As her condition worsened, she was taken to a high-end hospital in Gurugram, where she was denied treatment due to their inability to pay up the mounting bills! He is today hopeful that things are changing and no other son would have to bear such helplessness in future. n
 
Sahani is a researcher with Public Policy Research Center.
 
(This article appears in the March 31, 2019 edition)

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