The seven decades of Indian independence have witnessed many plans, papers and proposals assigning high priority to the health of the citizens of our country. The Indian healthcare sector has transformed significantly, particularly in the last two decades, an era that witnessed strong economic growth.
With National Health Policy 2017, the NDA government has accorded top priority to the sector. The policy is aligned to the WHO slogan of ‘Health for all’, and aims to deliver on the ‘Millennium development goals’ objective of Universal health coverage.
The policies and schemes under the NHP 2017 aim to deliver meaningful actions on ground and create significant positive impact. The Ayushman Bharat Mission seeks to leverage and enhance utilisation of available healthcare delivery capacity and also improve accessibility of healthcare services, especially to the marginalised sections of our society. The Pradhan Mantri Rashtriya Swasthya Suraksha Mission/Yojna (PMRSSY), as a part of the centre’s Ayushman Bharat mission, is expected to become a principle vehicle for achieving universal health coverage, which aims to ensure that citizens of this country are able to access good quality and affordable healthcare.
Presently, according to national health profile report, less than 20 per cent of the population in the country is covered under some form of health insurance. Out-of-Pocket expenses are very high at around 60 per cent and the new scheme would certainly help the marginalised sections of society to meet their healthcare needs. The economic survey 2017-18 has also flagged the issue of high levels of Out-of-Pocket expenses on health, which adversely impacts the economically deprived sections and widens economic and social inequities.
The PMRSSY seeks to provide access to quality healthcare to a vast majority of the rural and urban poor. It aims to cover the health care costs of up to INR five lakh per annum per family, for 10 crore households, thereby protecting them from likely impoverishment due to health-related expenses, and allows them to choose between public and private healthcare providers for any treatment and hospitalisation.
To ensure success of this flagship initiative, the government needs to address issues related to timely payments, as well as treatment reimbursement rates. The government has issued a draft model tender document, along with the pricing of comprehensive service packages. For example, it has proposed price of knee and hip replacements at INR 9,000 each, cardiac stent at INR 40,000, coronary artery bypass grafting (CABG) at INR 1.10 lakh, caesarean delivery at INR 9,000, vertebral angioplasty with a single stent at INR 50,000 and hysterectomy for cancer at INR 50,000.
Representations by industry associations like NATHEALTH, AHPI, CII, FICCI and others have been made to the government to relook at the pricing of procedures, as they appear to be abnormally low, in several instances even below CGHS rates. Tertiary care hospitals with NABH accreditation, high investment in land and building, medical manpower and technology, and with contemporary modern systems are severely challenged by the price points on offer.
There is an urgent need to put into place a transparent mechanism for a fair price fixation that works effectively for the sector. It is evident that most tertiary care treatments can only be delivered in super specialty hospitals that have invested heavily in quality, patient safety, infrastructure, technology, and manpower. It is important to understand that many of the 1300+ listed procedures can be carried out only in quality focused, tertiary care hospitals where the charges/fees need to take care of the much needed investments made in clinical and non-clinical manpower, medical technology, operational excellence etc.
The Way Forward
To achieve the goals under the PMRSSY, all stakeholders need to be fully aligned to delivering good outcomes and meeting their respective contractual obligations. It is essential that in the implementation of this programme, adequate care is taken to ensure that the overarching objectives of accessibility, affordability, and reliability are met; that in doing so, all our country’s resources, be private or public, are harnessed meaningfully for the benefit of our citizens. This programme should serve as a platform for strengthening India’s pre-eminent position as a high quality and low cost deliverer of healthcare; the Indian healthcare delivery model, if handled with care, has the potential to address the developing world’s health in the coming decades.