FM DECEMBER 2018 ISSUE - digital edition

column
the catalyst
Ayushman Bharat:
A two-month scorecard
Initial analysis shows the national health insurance
programme needs an urgent ramp up
MURALIDHARAN NAIR
I
had written about the Ayushman Bharat
(AB) scheme just around the time when
it was being launched nationally by the
Prime Minister in September. The article had
attempted to analyse and comment on the
preparedness of the centre and the states,
and what would matter for the success of
the programme.
At the time, much of the analysis was
based on conjectures, in the absence of any
tangible data points to assess our readiness
to launch a scheme of such magnitude.
While it was my conviction then, and now,
that the timing of the launch had less to
do with preparedness and more to do with
political exigencies, a certain degree of
performance must be ensured even if the
eye is primarily on reaping political benefits
from the launch.
Now, we have the first set of data points
on the actual performance of the scheme
after two months of launch. These are as
follows:
1) Total number of beneficiaries - 2,32,592
2) Share of care provided through public
health facilities - 32%
3) Top five specialities by claim -- oral and
maxillofacial surgery, general surgery, general
medicine, ophthalmology, obstetrics and
gynaecology.
4) Top five states by usage: Gujarat, Tamil
Nadu, Maharashtra, Chhattisgarh and West
Bengal.
Before offering a critical analysis of this
data, I must clarify that I am acutely aware
that two months are too short a period for
any definitive evaluation of a scheme of
this magnitude. It is also very heartening
to see that the programme has been set
in motion, unlike many other well-meaning
schemes of this kind that get mired in
endless intellectual/bureaucratic muddle,
either to die a quiet death or be subjected
to significant delays. Having said that, it is
important to highlight what needs to be
corrected with an utmost sense of urgency
to ensure that the scale-up happens in the
most efficient manner for a scheme that has
life-changing implications for its beneficiaries.
With the aforesaid background, my views
on the aspects of Ayushman Bharat that
need correction are as follows:
1. Improve communication and
outreach: An analysis of the number of
beneficiaries reveals that only 20% of the
actual hospitalisation cases occurring in
the target population is currently under
the scheme. That is to say, out of every 10
people actually getting hospitalised in the
target group eligible for AB, only 2 or fewer
are availing the benefits of the scheme. This
can be derived by comparing the actual
hospitalisation rate of the target population
group before the launch of the scheme in
the 18 states where the scheme is being
piloted and the number of beneficiaries
hospitalized under AB in the first two months
of the scheme. It should be noted that the
actual number of states where the pilots are
running is reported to be 22, but only 18
have been mentioned on the AB website.
Hence, this is a conservative estimate. Even if
it’s just a two-month-old scheme, a figure of
less than 20% is too low. Given that it is an
16 / FUTURE MEDICINE / DECEMBER 2018