Today's Editorial

11 June 2018

A patient-centric Ayushman Bharat

Source: By Ratna Devi: The Financial Express

We did well with MDGs and will do better with SDGs. Ayushman Bharat will adequately address SDG Goal 3 and ensure that healthcare reaches the most underserved and vulnerable populations”. I heard this at a think tank meet held just after the inaugural announcement of Health and Wellness Centres (HWCs) by the Prime Minister. The think tank had everyone, but I could not see a patient representative invited.

Ayushman Bharat comes as a relief for a vast chunk of the population constantly stressed with the rising cost of healthcare. The flagship health initiative has two dimensions. One, it aims to roll out comprehensive primary healthcare with HWCs serving as the first point of contact for those seeking health services, incorporating the much-needed preventive and promotive aspects of healthcare through screening and counselling.

Two, it aims to provide health cover of Rs 5 lakh per family per year for hospitalisation in secondary and tertiary care facilities. It is expected to cover half a billion people and align with the programmes of some state governments that have adopted an insurance-based model, with significant resources coming from the Centre. The access to healthcare is cashless and nationally portable. Treatment will be provided by empanelled public and private hospitals.

All this sounds good. The patient community, however, is concerned. Such promises are not new. In 2016, the government had launched a similar scheme with a lower limit and hardly anyone subscribed to it or benefited from it. The Rashtriya Swasthya Bima Yojna (RSBY) has not provided much relief and other state and central schemes have had significant challenges.

An original article in the Journal of National Accreditation Board for Hospitals & Healthcare Providers, titled ‘Assessing Indian Public Health Standards for 24×7 primary health centres: A case study with special reference to newborn care services’, concluded that “the availability of human resources, infrastructure and facilities for newborn care services at 24×7 PHCs were not satisfactory as per the prescribed Indian public health standards.”

In the 70 years of independenceIndia hasn’t added any new healthcare service providers except ASHA (Accredited Social Health Activists) to its health workforce. With huge gaps in infrastructure and human resource, health protection for secondary and tertiary care seems impossible.

Patients are also worried there might be exploitation and unnecessary procedures. With purchasing of healthcare from the private sector to fill in the gaps of the public sector, and a weak regulatory mechanism to oversee/monitor this sector, gullible patients might end up being advised unnecessary surgeries or extended hospitals stays.

Clarity on mechanism for uniform quality of all packages and services is missing. Standardisation of service quality across provider categories will be difficult to implement. Although NABH accreditation ensures quality, a small number of hospitals is accredited and most lack basic infrastructure.

More worrisome is that large sections seem to have been forgotten—people with rare diseases do not need hospital stays, nor can wellness centres help them. Most need nutritional therapyassistive devices and psychosocial support. The rare disease community is wondering where this will come from and what kind of support is built for them for diagnosis, which is often complicated and expensive.

Also, 80% of patients with NCDs can manage their condition on their own with proper medication and lifestyle changes. But there is no provision for counselling, early diagnosis and medication in Ayushman Bharat, critical for keeping patients out of hospitals.

Lastly, a vast segment of population feels that Ayushman Bharat should not be restricted to just the vulnerable. A school teacher who doesn’t qualify for Ayushman Bharat sadly said, “When it is the matter of healthcare, everyone is vulnerable. Like education, healthcare should be for all; otherwise one episode of critical illness will drive me to poverty. The private sector may not wish to take care of me because of my inability to pay and the government already has a long wait list. Where will I go for my treatment?”

One also wonders how the vulnerable will be identified. There have been huge pilferages in welfare schemes meant for vulnerable populations, is it housing, livelihood, sanitation or disasters. How is the government going to ensure that the neediest benefit from this scheme? These are the concerns that will hopefully find address once the programme is rolled out and the challenges identified. Until then, one hopes that at least some people will benefit and that the useful lessons learnt will shape better policies in the future.



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