Ayushman Bharat Diwas: Potential for Private Sector in India

Ayushman Bharat Diwas is being observed across the country today. It’s a significant day because it stands for affordable medical facilities to the hardest-to-reach. What better circumstance to appreciate affordable healthcare and universal health coverage than the current COVID-19 outbreak which has gripped the world?

What is Ayushman Bharat?

Ayushman Bharat – Pradhan Mantri Jan Arogya Yojana (PM-JAY) is one of the most ambitious government schemes yet, enabling India to achieve its avowed goal of Universal Health Coverage (UHC) by 2030. 

Billed as the world’s largest scheme of its kind, the PM-JAY, launched on September 23, 2018 has a target of 10 crore families, extending them coverage of tertiary care hospitalisation. Within a year of its launch, the scheme which provides annual coverage of INR 5 lakh per family, as many as 46.5 lakh patients have already availed of the benefit. Find out more about it on the official portal for Ayushman Bharat scheme.

Two facets of Ayushman Bharat

While the health and wellness centres (HWCs) aim delivery of an expanded range of services close to the community, Pradhan Mantri Jan Arogya Yojana (PMJAY) focuses on providing secondary and tertiary care services to the underprivileged section of the society. It is not the health insurance coverage alone; equally important is another dimension of the scheme. Under Ayushman Bharat, 1.5 lakh health and wellness centres would be set up in the country, making it one of the largest public primary healthcare networks in the world.

Being the second-most populous country in the world with 1.3  billion people, India has entered a demographic dividend phase. It means a significant bulge (over 66%) of our population is in the high consumption/ working age of 15-64 years. Writes Deepak Sood, Secretary-General, ASSOCHAM in a report about Ayushman Bharat: This advantage is going to last till 2055; but then, people have to be healthy and educated so that India can boast of its human resource which is amongst the best in the world. This scheme is a critical pillar here.

Scope for private sector partnerships

The current design of the programme clearly calls for synergistic collaboration between the government and private sector to nurture the vision and turn it into reality. Whether it is the involvement of private healthcare providers in ensuring quality secondary and tertiary care services to Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) beneficiaries or support for enabling digital health and screening programmes for strengthening primary healthcare in health and wellness centres (HWCs), the private sector can be leveraged in all the aspects of the programme.

Synergistic partnerships between the government and the private sector offer ways to contain the potential costs by capping commitments into the long term and leveraging ultra-lean models of care provision. Partnerships with the private sector can be leveraged by maximising with increasing the output for government with limited public capital; ensuring quality healthcare services to the people and enabling sustainable return on their investment for private players. These collaborations can help ensure greater efforts towards developing future care models that can expand via access through technology, standardisation, skills mix and economies of scale. 

Said Elias George, Chairman of Infrastructure, Government and Healthcare practice (IGH), KPMG India in an interview: “Partnership of the Ayushman Bharat Yojana with private sectors can be leveraged in all key areas such as ensuring patient engagement, provisioning of standardized care, grading performance of hospitals, mitigating fraudulent activities by leveraging innovative digital solutions, and developing future care models…” 

Working with insurance players 

AB-PMJAY provides the flexibility of mode of implementation to its participating State. Many participating States are greenfield and have faced several challenges in planning, implementing and monitoring of the scheme mainly due to lack of experience. Insurance players could play a very important role in administration of the scheme and the government could play a role of payer and regulator. Insurance players are highly regulated by IRDA and it enacts standard operating procedures and compliances to safeguard both, the beneficiaries and the payer. 

Digital health in India

Another area with huge potential for collaboration is digital health. India has witnessed emergence of large number of digital health players in the last five years. Some of the digital health players have adopted innovative technologies and business models breaking the barriers of distance, infrastructure and human resources. Increasing virtual consultation, telemedicine, health ATMs, e-PHCs, digital dispensaries and digital health technology players have showcased huge potential to bridge current challenges in public health.

There is increasing use of Artificial Intelligence, Machine Learning and sensor technologies in areas of early detection of diseases, disease management and treatment. Such digital health private players could be leveraged for HWCs and also AB-PMJAY in terms of fraud management, analytics, and technology-enabled third-party monitoring and evaluation of the scheme. 

Going by the proverb, well begun is half done, it’s imperative that both the government and private players foster dialogue with each other by building a collaborative forum.