‘We are moving towards universal health cover’
Prime Minister Narendra Modi will launch the Ayushman Bharat scheme on September 23 in Ranchi, followed by the nationwide launch of his government’s flagship health insurance programme that aims to provide ₹5 lakh hospitalisation cover to up to 107.4 million poor and vulnerable families. How prepared is India for the rollout? Union health minister JP Nadda tells Sanchita Sharma why he is confident about the programme being on track, and how the remaining challenges will be overcome.
How ready are the states for the Ayushman Bharat launch on September 23?
We’ve come a long way since the scheme was announced in the Union Budget on February 1. In February itself, we held consultations with states to discuss their concerns, how they wanted to get involved, their level of involvement, what they wanted from this scheme, et cetera. We next had consultations with stakeholders and the DGHS (director general of health services) office was asked to identify secondary and tertiary care procedures (offered free under Ayushman Bharat). In March, we got the approval of the cabinet very fast.
Is it the fastest approval for a health programme in India?
Yes, we got it on March 20. We next established the National Health Agency (NHA) and asked for state health agencies to be formed. By June, 19 states came on board and we started working jointly.
The programme gives health insurance coverage to 107.4 million families and more than 550 million people. As it will be digital, paperless and cashless, we have got the best in the field of IT on board. There are three financing models — insurance model, trust model and hybrid model— and 19 states have chosen a trust model.
What is the level of preparation in the states?
The letters with individual QR codes are being printed and will start getting distributed. Around 10,000 ‘Arogya Mitras’ from empanelled hospitals are being trained by the National Skill Development Corporation to act as an interface between patients and hospitals.
Individual beneficiaries will take letters with QR codes to an Arogya Mitra at the hospital to get a card with the names of all the family members. Around 80% of the identification process in rural areas and 70% in urban areas are complete. This week, ANMs (auxiliary nurse midwife, a village-level health worker) will start distributing the letters.
Doctors can prescribe 1,350 procedures and packages and, after a patient is admitted, treated and feedback taken, the payment will be done within 15 days of the patient being discharged.
Do the beneficiaries fully understand the benefits?
Things are still unfolding. Only when the letters reach the beneficiaries will they understand and react.
The common service centres — around 300,000 are being set up — will tell every individual whether they are on the list or not, and then people will go to Arogya Mitras.
That’s when the discussions will start.
What about approval for medical emergencies?
In a medical emergency, you can get pre-approval for procedures. If the approval doesn’t come in half an hour, it is deemed to be approved.
How will you prevent and detect fraud?
There are 94 types of automatic checks in the digital system that will set off alarms if it detects aberrant data. There will be social audits. We will also learn as we go forward.
What about data privacy?
Data security of international standards has been maintained. We did not have SOPs (standard operating procedures) for it in India, so we have adopted international SOPs as our own. This is the first time such data security systems are being used in India.
Are you saying my data with the Ayushman Bharat system will be safer than with a corporate private hospital?
Private hospitals follow security but they don’t have standardised data protection procedures.
How many hospitals have applied for empanelment?
We have more than 10,000 applications.
It’s not enough to treat 107.4 million families...
No, but it’s a start. The IMA (Indian Medical Association) has signed an MoU — it is on board. Other hospitals will come on board.
Why are you so confident?
It’s a ₹5 lakh cover for 55 crore people! The whole scenario will change because of the numbers that will come to get treated. Today (September 11) Tamil Nadu signed, Karnataka is coming on board the day after tomorrow (September 13). Kerala is still dealing with the floods. Punjab is going to come, Telangana is on board.
Are Delhi and Odisha resisting because of upcoming state elections?
They know their minds best, but I will appeal to them time again and again (to come on board). Today (September 11)I appealed to Delhi again. People should get the benefits. I also said this to Naveen Patnaik ji.
Tamil Nadu has a scheme where higher grade hospitals have higher packages.
We also have gradation — a hospital and a nursing home can’t have the same payment system. As services improve, the packages go up accordingly. Ayushman Bharat is applicable for district hospitals and above. It is for lifesaving procedures in hospitals with the capacity to do it.
What about primary healthcare, screening and referrals?
We have projected to have 150,000 health and wellness centres by 2020. There is a road map. At this point, 2,500-plus are ready, and by the end of the year, we will cross 10,000. Next year, we’ll add 40,000 and keep scaling it up.
The reason why it is 10,000 to 15,000 initially is because manpower is being trained. Once we have trained staff and more trainers, we will scale up.
What is the expected budget after a full rollout?
It’s an open-ended budget. I’m reiterating that the Prime Minister’s priority is to see change on the ground. I’ll give you one example. The PM came up with a programme called Pradhan Mantri Dialysis Yojana. Where was the budget? But in the first year, ₹900 crore was provided for it. In the same way, the National Health Agency (NHA) will get the money because the payments have to be done within 15 days. We have to give penalty if the payment is delayed beyond 15 days.
How much will the penalty be?
It will be according to the rates. The NHA will decide, but all payments have to be made within 15 days, so budget is no issue.
Does this mean India’s public health spending will increase next year?
It will increase after this. You see, when health coverage expands so much, it will automatically go up.
By how much do you expect it to go up next year?
As needed. The way it works is, we write to the finance department and we get it. The finance minister has openly said that whatever you need for it, you’ll be getting it.
How often does the PM take review meetings? What does he discuss?
Every week. All details, all presentations are discussed — how will it be rolled out, what are the systems being used.
What is the biggest challenge?
We need to strengthen IT to roll out a programme on such a big scale.
Why do several beneficiaries still do not know about Ayushman Bharat.
That is going to happen only when they get letters, not before that.
What is the delay?
The data has to be absolutely correct. People spell their names in different ways. Prakash may be spelt ‘Parkash’ or ‘Prakash’. Balvinder may be spelt ‘Balvindra’. We have to get the right person, and IT has to catch that and use that QR code to also include the family members.
How will the eight EAG (empowered action group) states with the weakest health infrastructure and human resources meet supplydemand gaps?
They are working very hard. Once you have the common man with ₹5 lakh support for treatment, hospitals will come up. And with hospitals, doctors will come.
The changes will happen in tier-two and tier-three cities, where more hospitals will open. Doctors, who work in large hospitals, will become mobile and visit different hospitals in other towns on different dates and days. They will visit, operate, and come back.
There is portability. Where there are no hospitals, people will go to other places for surgeries, like they are doing today. But today they don’t have money; tomorrow they will have money.
And when the money stays in hospitals, they will use it to consolidate and develop infrastructure and capacity.
How will you ensure there is an uninterrupted supply of drugs?
The free drugs and diagnostics supply chain is being made more robust. We are using IT-enabled systems to monitor medicines stocks in community health centres (CHC), primary health centres (PHC) and sub-centres to ensure stocks don’t run out.
Under free drugs and diagnostics, around 50 types of drugs and five tests are being done at PHCs, more than 100 drugs are available at CHCs, and more than 600 drugs at district hospitals. It will all be digitally managed.
The Centre has assisted states with more than ₹16,000 crore over four years for drugs and diagnostics.
How will patients’ grievances be redressed?
Complaints can be made online and offline to the state health agency and within 15 days, they need to submit the report.
Is Ayushman Bharat a step towards universal health care?
It is a major step towards it. On the one hand, it takes care of the secondary and tertiary health of the poor, vulnerable and marginalised, and on the other, it offers universal health screening of cervix cancer, breast cancer, oral cancer, hypertension, diabetes, tuberculosis and diabetes. Then we have free drugs and diagnostic facilities for all.
When universal screening begins, it becomes universal health coverage. We are on track.