Eligibility and benefits of the scheme:
1. The benefit of cover Rs. 5 lakh per family per year. More than 10 crore families belonging to poor and vulnerable population based on SECC database will be the target beneficiaries of the scheme.
2. The cover will take care of almost all secondary care and most tertiary care procedures.
3. Under this project, the entitlement will be decided on the basis of deprivation criteria in the SECC database. The different categories in rural area include families having only one room with Kucha walls and kucharoof; families having no adult member between age 16 to 59; female-headed households with no adult male member between age 16 to 59; disabled member and no able-bodied adult member in the family; SC/ST households; and landless households deriving major part of their income from manual casual labour, as mentioned on the official website of Ayushman Bharat scheme-abnhpm.gov.in.
4. Automatically included families in rural areas having any one of the following: households without shelter, destitute, living on alms, manual scavenger families, primitive tribal groups, legally released bonded labor, will also come under this scheme. For urban areas, 11 defined occupational categories will be entitled under the scheme.
5. There will be no restriction on family size, age, and gender under ‘Ayushman Bharat’ scheme to ensure that nobody is left out (especially women, children and elderly).
6. Under this scheme, the treatment in case of hospitalization will be free of cost for the family.
7. All pre-existing conditions will be covered from day one of the policy. The benefits cover will include pre and post hospitalization.
8. The beneficiary will be able to go to public or empaneled private hospitals across the country and get free treatment.
9. The beneficiary will only need to carry any prescribed ID to receive treatment at the hospital.
10. According to Dr. Dharminder Nagar, MD, Paras Healthcare, “Government is acting strongly and actively in making ‘Ayushman Bharat’ a reality.  PM’s announcement of rolling the policy under ‘Pradhan Mantri Jan Arogya’ through a technologically driven transparent platform speaks of government’s vision. We hope that Ayushman Bharat paves way for a concerted effort on improving country’s healthcare facilities.”

India is a country of diversity with 1.3 billion population of which 70 per cent resides in villages and have access to 30 per cent of medical assets of the country. Poverty is a significant issue of the country, despite having one of the fastest-growing economies in the world, clocked at an economic growth of 7.6 per cent in 2015. It is estimated that 23.6 per cent of Indian population, or about 276 million people, live below $1.25 per day.

As Health is a state subject-there is lot of mismatch in states like Kerala and Punjab have best health indicators, while Uttar Pradesh is the poorest as per the NITI Aayog report. Indian government spends approx. 1.5 per cent of its GDP on health sector and mplans to make it 2.5 per cent which is much less than many developing countries while the USA has dedicated 16 per cent of its GDP. India is riddled with very basic public health issues leading to disease burden. Keeping this in mind, Prime Minister Narendra Modi has launched six initiatives: Open Defecation free country by 2019, Swachh Bharat Mission, National Health Policy 2017, Digital India with e-health, medical device manufacturing and door-to-door screening of chronic diseases.

The healthcare needs holistic approach which depends on multiple factors. The present government has taken many positive steps including launching of National Health Policy 2017 after the gap of 12 years. It has announced many initiatives like health insurance of people who cannot afford basic healthcare and upgrading of health infrastructure.

The regulation of medical devices have been brought out and is applicable w.e.f January 1, 2018 ending uncertainty of medical device manufacturers having global market of 220 billion US dollar. Challenges bring opportunities such as Indian healthcare market is around US$ 100 billion while it is expected to grow US$ 280 billion by 2020. The healthcare IT market is US$ one billion and is expected to grow 1.5 times by 2020. There is requirement of 7 lakh hospital beds which need investment opportunities of 25-30 billion US dollar. We need to bring innovations in hospital planning,devices, diagnostics, drugs and use of technology to reduce healthcare delivery cost and yet quality.

We failed targets of Health for All by 2000, National Rural Health Mission, and Millennium Development Goals and now launched Universal Health Coverage; its success would depend on providing healthcare facilities and strict accountability. We need to focus on primary health care and customise our healthcare delivery system by learning from experiences of other countries.

The concept of Diagnosis Related Group (DRG) making financial package for group of diseases which is known to patients, providers and third party payors should be considered by improving deficiency found in its execution by the USA.

The various schemes of present government are appreciable but success would depend on strict monitoring, corporate hospitals have high cost and many unethical practices are reported every day in media. Public hospitals to National Rural Health Mission have not delivered as required because of corruption, lack of resources and application of management practices. The need is not old wine in new bottle but strict control in implementation of various schemes launched.

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Read all the issues of InnoHEALTH magazine:
InnoHEALTH Volume 1 Issue 1 (July to September 2016) – https://goo.gl/iWAwN2
InnoHEALTH Volume 1 Issue 2 (October to December 2016) – https://goo.gl/4GGMJz
InnoHEALTH Volume 2 Issue 1 (January to March 2017) – https://goo.gl/DEyKnw
InnoHEALTH Volume 2 Issue 2 (April to June 2017) – https://goo.gl/Nv3eev
InnoHEALTH Volume 2 Issue 3 (July to September 2017) – https://goo.gl/MCVjd6
InnoHEALTH Volume 2 Issue 4 (October to December 2017) – http://amzn.to/2B2UMLw
InnoHEALTH Volume 3 Issue 1 (January to March 2018) – https://goo.gl/fksdQx
InnoHEALTH Volume 3 Issue 2 (April to June 2018) – https://goo.gl/grbtRo

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