AB – Translating dream into reality | Dr Alexander Thomas

India spends around one percent of its GDP on public Healthcare, which is one of the lowest proportions in the world. A program of the magnitude of Ayushman Bharat would need a larger outlay and therefore the Government need to provide adequate financial resources to make it operationally viable and sustainable. There is no doubt that if appropriately planned and implemented, it will provide access to quality healthcare to the poor in our Country.

Some of the key factors to be considered for successful implementation of Ayushman Bharat Yojana;

1. Quality – Ensuring quality in healthcare is an important factor and it is commendable that Government is incentivising quality by paying extra compensation for hospitals with NABH accreditation and those running DNB training programs .In the long run, Government must institute mechanism to audit clinical outcomes of empanelled hospitals, which will set the trend towards enhancing patient safety and ensure quality healthcare.

2. Making Government hospitals vibrant – The Government health Institutions should be made more vibrant with focus on preventive healthcare as one of the prime functions. Reforms in medical education should be fast tracked and sufficient increase in under graduate and post graduate seats should be effected and it should be made affordable. Though the Government has more than 60 percent of inpatient beds, it is the private sector which provides 70 % of secondary and tertiary care. This situation must change, adequate staffing and accountability would alter this scenario and Government should become the major provider of health.

3. Financial Viability – At the present time private sector provides majority of secondary and tertiary care and will be the mainstay of the scheme. It should be ensured that these institutions are viable and continue to provide services required. One of the few credible scientific, indicative (costing study) third party verified, involving all stakeholders and the clinical pathway endorsed by the corresponding academic wings of the respective specialities and carried out by the Knowledge Commission ,Government of Karnataka  more than a year ago indicate that the present rates may not be sustainable. It is imperative that far larger study encompassing all the procedures included in the Ayushman Bharat Scheme be planned.

As is being discussed in Karnataka, the Government may consider the possibility of co-payment by above poverty line patients. This will also help hospitals in cross subsidising.

Finally the Government should ensure, prompt payment. Experience with CGHS and even with some of the state government schemes has not been encouraging.

4. Technology – Appropriate use of modern technology is to adopted in order to keep misuse at the lowest level and to ensure maximum utilisation of available resources.

Next article: Game changer — Healthcare reform | Himanshu Baid