For those who have been in the healthcare industry for many years, they all must have often come across the question as to how one can make quality healthcare more accessible and affordable. A lot of formulae have been shared on various platforms but no answer has seemed satisfactory to the wider audience, or has been accepted as a manageable template.
While the public healthcare delivery system has worked on its own model for decades but has often been plagued with the weight of having to serve a country of 130 crore, private healthcare service providers have also tried to work their way around in providing the best care at acceptable rates. For the latter group, however, the fact that a large percentage of the capital expenditure gets invested into new technologies and equipment, besides as payout for quality doctors and staff, sometimes makes it difficult to keep a low price mark.
This is where ambitious schemes like Ayushman Bharat, along with others introduced by state governments, like Sishu Saathi and Swasthya Saathi in West Bengal, come into the picture. As the Ayushman Bharat policy started being implemented since September 2018, the healthcare sector in India was seeing the beginning of a paradigm shift. The health insurance launched by the government has the potential to positively affect lives of nearly 10 million families, or in other words, around 50 million poor and vulnerable people.
The ambitious scheme offers an annual health cover of Rs 5 lakh per family from economically weaker sections of society, as determined by the Socio-Economic Caste Census database. Under the scheme, enrolled families will receive cashless treatment, from more than 1,350 packages of various surgeries and procedures, including treatment for knee replacement, coronary bypass, and stent implants, at rates almost 20 per cent lower than under the Central Government Health Scheme.
A primary benefit of Ayushman Bharat is the absence of any cap on the size of the enrolled family or the age of its members, besides the added advantage that the benefits of the scheme can be accessed anywhere across the country at any healthcare service provider empanelled under the scheme. Once properly in place, the policy could bring about a sea change, ensuring smooth movement and a standardised regulation, involving the government, insurance companies and TPAs.
The scheme, however, is not without its challenges. The primary challenge here, particularly for private healthcare service providers, is the pre-determined rate of packages available under the scheme, decided by the Central government. The primary concern here is that since the private healthcare sector has much higher capital investment in manpower and infrastructure, fixed low rates, particularly for high-end surgeries and procedures will prevent them from spending more on infrastructure or getting suitably qualified doctors. A 2018 report on Ayushman Bharat, formulated jointly by CII and leading consultancy firm PWC, found that a key element in smooth implementation of the scheme will be a need for the right infrastructure.
This is where private healthcare service providers have a major role to play, given that infrastructure development will not be as easy under the government-run healthcare system. Private hospitals will have to come forward and meet demands of the increased bed capacity, along with access to better and advanced technological and technical support. While it will take some time for the policy to be implemented, almost all private healthcare service providers will have to get empanelled under the scheme because of its wide-ranging nature.
Once properly implemented, the Ayushman Bharat scheme could have a positive impact on reducing direct payout for patients. Not only will the economically vulnerable get access to health coverage, the scheme could have a positive snowballing effect, leading to better and timely treatment protocols, higher clinical excellence, and hence, higher patient satisfaction.