- Ajay Bi­jli, chair­man and man­ag­ing di­rec­tor, PVR Cin­e­mas - Ayush­man Bharat - Spir­i­tual Corner: Sci­ence of Karma

India Business Journal - - CONTENTS - AYUSH­MAN BHARAT

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.

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