Achieving universal coverage

Exactly one year ago, the government of India announced the arrival of the landmark Pradhan Mantri Jan Aarogya Yojna (PM-JAY), or Ayushman Bharat, as it has come to be known. The plan was to provide free healthcare to the most economically poor 50 crore Indians, who otherwise would have no access to quality care. The idea was simple and to be executed in two phases. The first, 'wellness' part aims to keep these 500 million out of the hospitals by starting 1.5 lakh wellness centres where basic healthcare is provided using advanced technologies like telemedicine, and preventive care in the true sense is promoted through the practice of Yoga and naturopathy. The second, 'curative', part dealt with providing insurance coverage of Rs 5 lakh for in-patient care at both public and private hospitals. Ayushman Bharat is India's move towards universal health coverage – where no patient is denied care for lack of money, and completion of its first year is a proud moment for everyone in the healthcare industry.

Then came the execution and as was expected, there were challenges. Much has been written, discussed and debated about the complexity of the challenges facing Ayushman Bharat – from prices offered being lower than the cost to perform the procedure, to insurance fraud, to states not accepting Ayushman Bharat. On the other hand, a patient, who previously did not have any access to healthcare, is receiving care every nine minutes, the top ten states providing Ayushman Bharat have catered to about 40 lakh patients. As is not surprising, with India's growing burden of cardiac disease, the three top procedures by amount spent by the government are single coronary stenting, cardiac bypass surgery and double coronary stenting, on which the government has spent about Rs 340 crores. In all, close to 45 lakh patients got treated at a total cost of Rs 7,500 crores – an average of about Rs 17,000 per patient.

Despite widespread reservations about low prices, of the more than 18,000 hospitals empanelled, more than half are private hospitals, and about 62 per cent of treatments have happened at private hospitals. While initially sceptical, I now realise that it is time for private hospitals to own up to this challenge and attempt to operate at the price point suggested by the government, which is open to dialogue and discussion given its dynamic leadership. Maybe it is time to envision 'Ayushman Hospitals' – a chain of 100-250 bed no-frills hospitals, built ground up, supported by the government, having specific specialities and services, to cater exclusively to patients from Ayushman Bharat. A hospital that does not rely on cross-subsidisation but instead is built with the vision of being a hospital of the masses. One which leverages top-end technology like machine learning, telecommunications, virtual and augmented reality and internet of things to bring down costs and still provide adequate quality healthcare to its patients. The government, including Prime Minister Modi, are aware of the demand-supply gap that exists between the patients that need care and the hospitals that provide care. The creation of a viable business model around Ayushman Bharat will not only encourage Indian entrepreneurs to invest in healthcare but will also drive foreign investment into the sector. I believe that rational engagement and conversation with the government can make this a reality, but the responsibility of engagement lies with the private sector. Both, providers of care, across the continuum, and producers of technology and healthcare products, need to come together to accept this challenge of translating this vision of universal health coverage into reality.

(The author is Founder & Chief Radiologist, Mahajan Imaging, Padma Shri Awardee and Former President of the Indian Radiological & Imaging Association. The views expressed are strictly personal)