- Ajay Bijli, chairman and managing director, PVR Cinemas - Ayushman Bharat - Spiritual Corner: Science of Karma
Prime Minister Narendra Modi knows very well that health is wealth. No wonder, the prime minister announced the Pradhan Mantri Jan Arogya Abhiyaan, also known as Ayushman Bharat, which is set to be rolled out on September 25.
Ayushman Bharat, the government-sponsored health insurance scheme, will provide free coverage of up to Rs 5 lakh per family per year at any government or even empanelled private hospitals all over India. However, since the scheme is meant only for poor and economically-deprived people, not everyone is eligible to get free medical insurance. The ambitious scheme will be available for 10.74 crore beneficiary families or about 50 crore Indian citizens.
Eligibility for the scheme, which provides insurance cover for secondary and tertiary care, is based on Socio-Economic Caste Census data-
base. In case of hospitalisation, the insured and his family members do not need to pay anything under the scheme, the insured goes to any government or empanelled private hospital.
Ayushman Bharat is unlike other medical insurance schemes, where there is a waiting period for pre-existing diseases. On the other hand, under this scheme, all kinds of diseases are covered from day one. The benefit cover includes both pre- and posthospitalisation expenses.
The government is betting on a model of dual sponsorship between the Centre and the States to finance the premium pay-out for the scheme. However, if adoption picks up, then claims are likely to far exceed the premium, thereby significantly increasing the cost of serving the scheme. To address this cost-escalation issue, the government needs to strengthen primary and preventive care system
in the country by working out a viable public-private partnership model. This will prevent many cases from reaching the hospitals, thereby lowering the claims burden for Ayushman Bharat.
The health insurance scheme can help develop an environment for emergence of new business models around health technology, revenue cycle management and primary care. However, it would require the government to think and act out of the box to prevent the scheme costs from ballooning out of control. It would also necessitate the development of a mechanism to monitor healthcare quality.
If effectively rolled out, Ayushman Bharat could well change the course of evolution of Indian healthcare. Cost-effectiveness and effective revenue cycle management will be the new success drivers for private healthcare providers.
Ayushman Bharat could well change the course of evolution of Indian healthcare.