Wednesday, February 14, 2018

Ayushman Bharat: India takes another baby step towards Universal Healthcare

India took another small step towards Universal Healthcare this month. The government announced the Ayushman Bharat scheme. The highlights of this scheme are:
  • Allocation of Rs. 1,200 for converting 1,50,000 health centres to comprehensive Primary Healthcare Centres covering a range of basic services
  • A National Health Protection Scheme (NHPS) where the government would cover 10 crore families for secondary and tertiary healthcare services 
Within a short span of time, several criticisms of the plan were voiced including the low fund allocation for the NHPS, lack of focus on strengthening the Public Healthcare system and the scheme being tailored to benefit private players.

The Niti Aayog held a press conference to clarify many of the misgivings. They stated:

1. There would not be any co-pay to be borne by the beneficiaries
2. There would not be any cap on the number of members of a family
3. The scheme would be funded jointly by the Centre and the states similar to how such schemes are regularly funded

Additionally, several clarifications were issued about the premium amount estimated, the modalities and timelines of roll out etc.

Whichever way you look at it, India has now firmly embarked on its Universal Healthcare journey. We may eventually reach true, genuine, uncapped, equitable and fair healthcare coverage for all citizens in many decades from now. But we have started on the journey. This is an important step in any country’s life.

Granted, there are many things that need to be fixed. There are many lacunae. But then, Rome, they say, wasn’t built in a day. To fix India’s healthcare system is an infinitely more complex task. Such a mammoth task would be impossible to get right in one shot, at one go. This is something that can only be done in an iterative manner. Implement things, figure out the kinks and then fix them in the next iteration. This process has to go on till a smooth system is established.

That is not to say that we must not learn from the mistakes of other countries. Worldwide, it has been proven that public healthcare systems are the ones that work the best in providing Universal Healthcare. India must strive to bolster its public healthcare system. The current, highly inadequate 1% of GDP that is spent on public healthcare needs to be tripled to reach somewhere close to global averages. We all know however that for our public healthcare infrastructure to reach optimum or even adequate levels of quality and access will take some time. In the meantime, we must continue to find other means to achieve partial success in some areas of healthcare.

Prof. Vivekanand Jha, Chief Medical Officer of NephroPlus and Executive Director of The George Institute for Public Health, India, summarises this best in an article in The Wire:

“Irrespective of the pros and cons, the most important contribution of the finance minister’s Union Budget speech is that for the first time, healthcare seems to have come to the forefront of public debate arena in India. It is important for all the stakeholders to ensure that this conversation stays alive. It is impossible to say how long it might take to reach a stage where access to essential equitable healthcare becomes a reality for a majority of the population, but we seem to have made a start.”

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