Not covered under Ayushman Bharat-PMJAY? How middle class can hope to benefit too – Explained

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Updated: September 23, 2019 12:45:01 PM

One Year of Ayushman Bharat: From being a "seller's market" to being more "patient-centric' is how AB-PMJAY is going to change the healthcare industry on a whole.

Ayushman bharat anniversaryAyushman Bharat has completed one year. Image: PMJAY website

Ayushman Bharat anniversary: It has been a year since Prime Minister Narendra Modi launched the largest healthcare “revolution” in the country with Ayushman Bharat-Pradhan Mantri Jan Aarogya Yojana (AB-PMJAY). The scheme has so far helped provide free treatment to around 47 lakh beneficiaries in just one year, according to Union health minister Harsh Vardhan. AB-PMJAY provides health cover up to Rs 5 lakh per family per year, covering around 50 crore beneficiaries. Under the scheme, beneficiaries get cashless and paperless access to services at the point of service. Although AB-PMJAY provides health cover only to the poor at present, in the long run, if successful, it is expected to benefit those not covered under this revolutionary scheme too, including the middle-class, in many ways. Wondering, how? You can understand this with an analogy.

‘Car for the masses’

Dr Vikram A Munshi, founder WhiteSpace, says you can understand Ayushman Bharat’s impact by comparing it with a car for the masses. “Let’s take PMJAY as a car for the masses. Any car needs a network of roads, highways, and expressways. If we take the current Indian healthcare system – it relies more on private healthcare infrastructure – thus the PMJAY Car owners have to come on private expressways connecting the metros and cities to drive their cars, which puts a lot of pressure on the infrastructure as well as the patient experience,” Dr Munshi told FE Online

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“Just the way the cars come first and the roads follow, the PMJAY will ensure a massive overhauling of the public healthcare infrastructure delivery which will be used not only for the PMJAY beneficiaries but the majority of the population,” he added.

The Ayushman Bharat-PMJAY scheme is based on the premise that with the rise in demand, supply of healthcare needs will expand in response. This will likely happen across segments like healthcare delivery, equipment, consumables, medicines, and diagnostics. With Ayushman Bharat, the government is also changing its role from being a healthcare “provider” simply a “payer”, says a White Paper on the scheme by SKP. It notes, “The program will bring health insurance coverage to a large section of the target population.”

Future extension for middle-class?

SKP Business Consulting LLP told FE Online that in the long run, the scheme will provide “the government with a unique opportunity to bring institutional reforms to a sector, where traditionally, change has been difficult to implement. It is possible for this scheme to be later extended to the middle-income segment of population. Ayushman Bharat will also help bring a mindset shift in both – the covered and uncovered sections of the population, by identifying healthcare as an important pillar for improving quality of life as well as economic prosperity.”

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‘Largest job creator’

PMJAY scheme is expected to create a large number of jobs in the healthcare sector. Health Secretary Preeti Sudan and PMJAY CEO Dr Indu Bhushan wrote in the Indian Express today that the expansion of AB-PMJAY will lead to creation of 7.5 lakh new opportunities for doctors, nurses, technicians, pharmacists and frontline healthcare workers like Pradhan Mantri Arogya Mitras. They say, “With its focus on delivering healthcare to a large population, Ayushman Bharat is set to become one of the largest drivers of jobs in the country. ”

Patient first, not profit: Impact on private hospitals

Dr Munshi says that the reduced reliance on private healthcare will ensure that “private hospitals become more patient-centric in their approach both in terms of cost and customer experience which will be of immense benefit to the customers of private healthcare.”

Ayushman Bharat scheme is set to affect the healthcare industry on a whole. From being a “seller’s market” to more “patient-centric’ is how AB-PMJAY is going to change the healthcare industry on a whole, feels SKP. “Traditionally healthcare has always been a seller’s market because of the lack of sufficient public health infrastructure comprising not only of facilities but also skilled healthcare workers. This seller’s market is never good for the buyer,” the business consulting said.

Earlier measures by the government was regulation-driven with focus on capping prices of medicines and devices. The governments of the past hoped the regulations would help in providing affordable healthcare to citizens. But these had “little or no impact”, said SKP. In contrast, the Ayushman Bharat-PMJAY scheme “is slowly ensuring that the healthcare industry gets sensitized towards being more patient-centric. The adaptation of technology to improve customer experience and reduce costs is also increasing. We see pharma companies introducing chatbots to increase customer education about specific diseases and numerous apps on managing diseases. All these are very good signs for both the patients and the industry.”

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Ayushman Bharat impact on health insurance sector

Dr Munshi said, “Any industry which caters to masses runs on volumes and if the government becomes one of the biggest buyers then that industry gains. With the kind of volumes of enrolment (approx 5 Cr people) envisioned with PMJAY, the industry will increase its penetration. Moreover, the increase in healthcare infrastructure will also ensure more people buying medical insurance thanks to increasing awareness which again is an added benefit. The other benefit which I see is that the insurance company will have access to massive amounts of data on the Indian population and their specific ailments. Using big data analytics, the insurance companies will be able to tweak their products, introduce newer products and sharpen their segmentation which will help increase both the efficiency and the effectiveness.”

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