Ayushman Bharat addresses demand-side health financing needs of poor

Sameer Kochhar, Author of ModiNomics, Defeating Poverty and Reforms Historian
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Modi government's flagship healthcare programme Ayushman Bharat completes one year in September 2019. This is one of the world's largest publicly funded healthcare initiatives. Indu Bhushan, Chief Executive Officer, Ayushman Bharat - Pradhan Mantri Jan Arogya Yojana (PMJAY), explains the achievements of the scheme in conversation with Sameer Kochhar, Chairman, SKOCH Group. Edited excerpts:

Sameer Kochhar: What is the importance and what problems are you trying to solve?
Indu Bhushan: It’s Prime Minister’s initiative, aimed to solve the problem of impoverishment because of the rising expenditure on healthcare. When a poor person gets sick, it’s not the person only who get sick but the whole family suffers. This should not be the case. Poor people should not forgo treatment or postpone treatment because of the lack of resources. Currently, about 6 crore people fall into poverty because of the expenditure on health. This scheme is helping people to avoid that kind of situation. It covers 40 per cent poorest population of the country. 

SK: There are many schemes on healthcare. States have different programmes. What is unique with Ayushman Bharat? 
IB: For 70 years, states have done a lot, so has the centre and we should acknowledge the contribution made through all the schemes. But those schemes as we call are the supply-side schemes. The idea was that we build hospitals, we provide services and the assumption was that after hospitals were built, services have been provided and poor people are going to benefit from these services but that didn’t happen. 

PMJAY has changed the incentive structure in the public sector. Even the smaller private hospitals are empanelled. They get resources if they give treatment to poor people on listed services. Poor get the treatment and hospital additional resources. This is called demand-side financing. The incentive structure has been changed both for the public sector and the private sector.

SK: Could you elaborate on the structure of the programme?
IB:  Key backbone of the whole programme is the IT framework. The IT platform is the one which connects our beneficiaries with the hospitals, insurance company and a state. Through the IT platform we identify the eligible beneficiary. With Aadhaar, we reconfirm that the person is the same or not. The IT platform records the entire stay of the person right from the admission to discharge. After discharge, the payment claims are also raised through IT platform and the payment is made through the IT platform. IT helps in identifying the person, recording the entire stay and raising the claim and making payment without any intermediary or human interference. 

SK: How are the list of beneficiaries being constructed?
IB: The list is based on 2011 Socio-economic Caste Census (SECC). In that Census all the households are mapped and it has some deprivation categories like people living in one-room houses, landless laborers, SC & ST, households headed by women and does not have any male adult member, etc. Households are included in the list on the basis on deprivation.

SK: This is household-level data and how does it get linked with Aadhaar because Aadhaar is individual-level data?
IB: In the household level data all the members of the household are eligible and we have the name of all the individuals.

SK: What are the major challenges you are facing? 
IB: The biggest problem is to reach the last mile. Many beneficiaries may not know about the programme. Awareness is a challenge. Another challenge is the scale of the scheme. It is meant for crores of people. This itself creates a problem. Different states are at different levels. Some states already have their scheme and challenge is that how to converge with them and some states don’t have any scheme so capacity was not there, any institutional structure was not there, so building that was a challenge. Then establishing IT platform was a challenge. There are many challenges that we still have like fraud and abuse.

(Sameer Kochhar can be reached at skoch@skoch.in)

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