IMA demands review of the concept and operational aspects of AYUSHMAN BHARAT
According to the Indian Medical Association, the money allotted for the National Health Protection Scheme would have better served the nation if every Government District Hospital had been strengthened with an infrastructure of Rs 2 crores each. The highly optic NHPS fails to create any new national asset. The same money invested in our public hospitals would have brought secondary and tertiary care closer to poor in our Government hospitals. In addition to non creation of new public sector hospitals, the scheme will lose around Rs 400 corers to private health insurance companies to manage the scheme. The insurance driven healthcare is a failed experiment.
IMA is of the firm opinion that the way forward for the country is to invest in our Government hospitals for better health infrastructure and manpower. 14 per cent of the GDP of USA is expended on Health. Yet 20 per cent of the American population do not have any health coverage due to the highly wasteful insurance model. The current policy change in India will only end up strengthening the insurance business. Moreover, fragmented approach to healthcare is unfortunate.
IMA has suggested to the Union Government that NHPS should be modelled as healthcare purchase directly from the provider hospitals removing the insurance companies and Third Party Administrators. These intermediaries siphon off 40 per cent of the budgeted money and are breeders of corruption and unethical practices. Such a direct model without insurance companies and TPAs was envisaged by the High power expert group constituted to study Universal Health Coverage.
Apart from such conceptual deficits the operational flaws of the scheme will ensure it as a non starter. The rates quoted by the Government are abysmal and impracticable. Most of them do not cover even 30 per cent of the cost of the procedure. No hospital can work on these rates without seriously compromising patient safety. In the garb of cost cutting the Government is exposing the people to danger in the hospitals. Caesarean sections underwritten for Rs 9000/- cannot ensure safety of the mother and the child. Safe confinement will require quality drugs as well as services of an Anaesthetists and Paediatrician. The Government has ordered for costing of the procedures as an afterthought after announcing the rates, IMA demands that the costing undertaken be transparent and be in public domain.
IMA is willing to partner the Government in Wellness centres collaborations, if the Government wishes to provide services under a medical doctor. Clinical services from clinicians will ensure patient care and safety. Non clinicians providing clinical care will actually be part of the problem rather than a solution. IMA is also concerned that the sub-centres which were created for public Health aims are being converted into dispensaries. In fact, a parallel system is being evolved.
Had the Government extended the insurance coverage to primary care, thousands of clinics and small hospitals situated in rural and semi urban area would have participated in the scheme. This would have made the scheme and the small hospitals viable and sustainable. IMA is concerned that the small and medium hospitals will be decimated with the current design of the scheme.
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