Together, Let’s Make India Healthy | Dr Bhupendra Kumar Rana

Ayushman Bharat-National Health Protection Mission (AB-NHPM) also fondly known as ‘ModiCare’ is an ambitious scheme of Government of India to provide a cashless cover of `5 lakhs per family per year for hospital care to about 108 million families. These families are identified based on a criteria using socio-economic status. The main objective behind the scheme has been to provide healthcare to these poor family members without any out of pocket expenditure. To provide affordable healthcare has been a challenge however it is not the only challenge as access to healthcare facility and then the quality and safe care are even greater challenges. Under the scheme, National Health Agency (NHA), the implementing arm under Ministry of Health would be empanelling the private and government hospitals and this will be a marathon task. This will require identification of healthcare facilities those are willing to provide care under the scheme and also ensuring a particular level of quality benchmarking. NHA has defined an empanelment criteria but again checking on the compliance with these criteria will be a challenge and would require additional resources. Prescribing accreditation will not help as there will be just few hospitals under that category, however encouraging a system of compliance checking and monitoring of the empanelment criteria may be an option to make the empanelment process successful and sustainable. This will provide an objective way of compliance to the prescribed empanelment criteria on a continuous basis by all empanelled healthcare facilities.

To effectively implement the scheme a proper coordination with the state health authorities is a must, as each state has its own style of functioning. A robust IT platform would be essential to minimise possible roadblocks for empanelment of hospitals, registration of beneficiaries, management of patient and treatment records, referral records etc. and to standardise the process and execution of the scheme. Pilot testing of an IT system has just started and we need to see how it will fare.

Insurance companies have already started talking about fraud management which means this is another challenge for the scheme to optimally utilise funds and maintain a low premium to be passed on to the insurance companies.

As the scheme is so huge both in terms of operations and finances that every penny saved would have a remarkable impact on the overall viability and future of the scheme. Therefore, looking for options to reduce burden on the hospitals would certainly help in sustainability. Home Health Care (HHC) is a concept wherein many of the needs of a patients can be taken care at the comfort of their homes and, therefore burden from hospitals is reduced to provide hospital care to more needy patients. As per the industry estimate, the cost of home healthcare is about 25 to 50 per cent cheaper than a hospital stay depending on the services taken. It also saves from the extra expenditures associated with a hospital stay. Which means, shifting from a hospital to home care would reduce the burden of NHA significantly and also hospital beds would be available to more needy patients.  However, in the absence of a regulatory or quality framework, HHC has not yet become an organised sector. To keep in mind the need, Quality & Accreditation Institute (QAI) has been working for last one year to develop accreditation standards for home healthcare using a technical committee of experts from this field.

Accreditation standards are now available for use and provides a framework of quality and safety in HHC. Industry has welcomed these standards and adopting to standardise their processes for better outcomes. As per the feedback from the HHC providers and insurance companies, this accreditation program is expected to support AB in a big way.

The scheme will be successful in many ways and it is a step towards Universal Health Coverage and Sustainable Development Goal-3 (Ensures healthy lives and promote wellbeing for all at all ages). AB-NHPM will change the face of Indian healthcare industry in a big way by throwing greater challenges and bringing more opportunities, both for providers and receivers of healthcare. We have a long way to go.

Next article: India’s tectonic shift towards UHC | Dr Rana Mehta