Sir Isaac Newton once said: “I shall not mingle conjectures with certainties." While trying to figure out the impact of Ayushman Bharat-National Health Protection Mission on India’s healthcare, we should push ourselves beyond such speculations and act in a more certain and timely manner.
A major chunk of India’s population is grappling with multiple health conditions requiring urgent medical interventions. The burden of infectious and non-communicable diseases, coupled with accidents and trauma, is yet another challenge for a middle-income country like India. Unfortunately, healthcare services for these conditions are either not available or not affordable, or both.
To the argument of some people on strengthening our health services to meet this gap, instead of allocating resources for demand, side schemes such as Pradhan Mantri Jan Arogya Yojana (PMJAY), we should acknowledge that the public sector provides for only one-third of hospitalized care, and the rest is provided by private hospitals. The government-run health facilities face acute shortage of human resources and infrastructure. The need of the hour is, however, to strengthen the supply-side and make it highly desirable, and it is indeed an ongoing process.
However, achieving the desired supply strength may take decades even with successful programmes such as the National Health Mission. Even developed nations, which are flag-bearers of health system reforms, have taken several decades to get their supply of health care services fall in place.
Moreover, strengthening of healthcare delivery system does not necessarily imply that the benefits will accrue to the neediest and the vulnerable. It warrants a multipronged approach.
Interestingly, studies suggest that people who are better off and have higher paying capacities are the ones who utilize the “free" health services more than those who have lower incomes and are less privileged. This indicates that certain deprived sections of the society shall still be left out if not for a targeted approach.
The private sector treats nearly 70% of ailments, but mainly serves those who have the ability to pay, and this is the major contributor to out-of-pocket health expenses. Demand-side financing is thus more a need than merely a strategy.
Demand and supply-side financing are not mutually exclusive, but rather complementary to each other, and have a synergistic effect on the improvement of health services of any country.
The PMJAY, under the umbrella of Ayushman Bharart, has a special role to play. It will provide power of choice to the poor and vulnerable families through a targeted approach. They can choose to visit either public- or private-empanelled hospitals to get treatment and, thereby, create healthy competition between health care providers.
Ayushman Bharat will certainly prove to be a pro-poor move and will keep all its core promises. Hope floats!
Indu Bhushan is chief executive officer of Ayushman Bharat-National Health Protection Mission.