FM DECEMBER 2018 ISSUE - digital edition

entitlement based scheme, the propensity to
avail by the beneficiary is extremely high and
typically such schemes are expected to result
in a rise in hospitalisation rates in the first
year. This is also corroborated, anecdotally,
in my conversations with the target group
population in multiple states where the pilots
are on. In fact, the states that have emerged
as leaders had a history of well-entrenched
state-sponsored schemes targeting at
least 50% of the target group which got
subsumed under AB. The beneficiary
numbers under AB would have been much
lower without the cannibalisation.
2. Focus on improving the share of
public health facilities: What is surprising
are comments from senior authorities
managing the programme, highlighting the
68% share of private healthcare providers as
a positive aspect, indicative of their adoption
THE PLANNED ECONOMICS OF
THIS SCHEME NECESSITATES
SIGNIFICANTLY IMPROVING
THE SHARE OF PUBLIC HEALTH
FACILITIES TO AT LEAST TO 50%
TO MAKE IT SUSTAINABLE
HOSPITALISATION RATES IN 18 PILOT STATES
State
AB Eligible
Population
Hospitalization
rate*
Arunachal Pradesh 381896.1 2.361182% 9,017
Chhattisgarh 17,495,693 3.8% 658,350
Goa 191,181 6.1% 11,735
Haryana 6,473,679 4.7% 302,288
Himachal Pradesh 1,972,401 3.5% 69,961
Jammu & Kashmir 4,079,255 2.8% 112,654
Madhya Pradesh 37,894,393 2.1% 778,202
Number of
hospitalizations
per annum
Maharashtra 41,552,599 4.5% 1,868,024
Manipur 1,434,866 1.0% 13,761
Meghalaya 1,538,761 1.9% 29,334
Mizoram 365,923 2.2% 8,176
Nagaland 869,815 0.5% 4,264
Uttar Pradesh 67,440,610 2.9% 1,930,534
Uttarakhand 3,190,169 1.3% 42,023
West Bengal 57,819,767 2.0% 1,146,539
Chandigarh 142,437 3.7% 5,287
Dadra & Nagar Haveli 145,065 1.6% 2,298
Daman & Diu 58,784 5.3% 3,113
Actual hospitalisation
of the target population
Hospitalisation claims under AB
(annualised based on 2 month data)
AB claims as a % of
actual hospitalisation
243,047,291 2.9% 6,995,559
1,458,000
20.8%
*As per NSSO or RSBY whichever is higher
of scheme. Indeed, support of private
healthcare is crucial for the programme,
but the planned economics of this scheme
necessitates significantly improving the
share of public health facilities to at least
to 50% to make it sustainable. Hence, the
deterioration in the public share to 32% from
34%, which is the current national average,
is not good news.
3. Speed up empanelment of the
tertiary care players: The specialities that
have come up on top are not typically found
to be so in a normal situation, particularly
ophthalmology and obstetrics/gynaecology.
At the same time, cardiac ailments, that
account for 10% of hospitalisations in India,
does not find a mention. This is possibly
owing to insufficient empanelment of highend
tertiary care private hospitals (given
the paucity of sufficient capability in public
health) which needs to be ramped up. The
good news is that oral and maxillofacial
surgery coming on top is perhaps indicative
of accident/trauma care getting the benefit.
In conclusion, it must be emphasized
that what have been commented upon as
areas of improvement are based on the
very limited data that has come into public
view. A more comprehensive view can be
taken after six months of implementation
and when more details are available, but
the government may not have the luxury of
time in this case. With the elections coming
up in six months, it is imperative for the
government to do everything it can to ramp
up effective usage of the scheme as soon as
possible.
The author has long-standing association with
EY India but the views are strictly personal.
DECEMBER 2018 / FUTURE MEDICINE / 17