Sixteen years ago, when there was drought in Karnataka, farmers lost the capacity to buy healthcare. I was able to convince the state government to launch a micro health insurance scheme through cooperative societies with a premium of Rs 5 per month per person. The government was kind enough to agree to be the reinsurer. Four hundred hospitals across the state agreed to treat these patients. This is how the Yeshasvini micro health insurance scheme was born.
In the following two years, similar schemes were launched by the governments of Andhra Pradesh, Maharashtra and Gujarat.
We tried desperately to convince north Indian states, but without much luck.
Even after 15 years of successful operation of Yeshasvini, micro health insurance remained predominantly a southern and western Indian phenomenon. Eventually, West Bengal and Rajasthan also launched their own state-sponsored health schemes.
The nation saw a tectonic shift in healthcare when the Hon’ble Prime Minister launched Ayushman Bharat on September 23, 2018. About 107.4 million poorest and most vulnerable families are today covered by health insurance which sponsors almost all the complex surgeries and 1,394 procedures, covering 23 specialties in both public and private hospitals.
A GAME CHANGER
Historically, surgery has remained the unwanted stepchild of public health system. Governments across developing countries are obsessed with malaria, TB and HIV. Unfortunately, malaria, TB and HIV collectively kill less than four million people a year across the world while lack of access to safe surgery kills 17 million people annually. Most of these procedures are simple operations called ‘bellwether procedures’ – surgery for burst appendix, caesarean section for obstructed delivery and surgery for compound fractures.
Sponsoring these operations can save millions of lives in India. With 65 million surgeries required to be performed every year, India is currently lagging as it performs only 25 million surgeries.
With Ayushman Bharat sponsoring almost all secondary care and most of tertiary care hospitalisations, things are nevergoing to be the same. Because of the large number of surgeries done in public and hospitals, better infrastructure will come up which can easily take care of malaria, TB and HIV, apart from all other
With the launch of the National Medical Commission by the government, the much debated shortage of medical specialists can be addressed in just three years.
Ayushman Bharat can transform healthcare by encouraging digital medical records.
The Joint Commission of the USA, which accredits American hospitals, showed that 65% of the sentinel events happening in hospitals which generally lead to death are due to communication failure. An inexpensive software, built locally, running on a mobile platform can turn India into the technologically most advanced healthcare system in the world.
Today very few surgical procedures are done in public hospitals. With the large inflow of patients who are covered by Ayushman Bharat, public hospitals must wake up to the reality of coping with a large workload. Financial incentive through Ayushman Bharat for medical professionals will certainly make a difference.
PRIVATE HEALTHCARE PROVIDERS APPREHENSIVE
Private healthcare was becoming unviable well before Ayushman Bharat, mainly because of the Central Government Health Scheme. The scheme, which sets the benchmark for procedural pricing for all government schemes, did not make major changes in its pricing of procedures, which is not scientifically arrived at, in the last 10 years. Compounding the problem was delayed payments by governmentsponsored health schemes, at times after more than a year.
Fortunately, Ayushman Bharat pays on time. The only grievance is the pending request for upward revision of some of the rates which I assume will happen soon.
I am convinced that within the next seven to 10 years India will become the first country in the world to dissociate healthcare from affluence. India needed two change agents – a financial intermediary to pay for medical treatments and a regulatory body to transform medical education to train adequate manpower to address the healthcare needs of 1.3 billion people. In the last three years, the government started laying the foundation for a paradigm shift by launching first Ayushman Bharat and then the National Medical Commission.
For the first time in our country, Ayushman Bharat agreed to pay interest in case of delayed payments. For the first time, I see political intention for a change and no one can come in the way of the change whose time has come.