I have failed to identify the Ayushman Bharat beneficiaries. The Ayushman Bharat execution is equally flawed as beneficiary identification, if not more. The scheme seems to have been arrived at by a politician proclaiming that he needs something good for the masses to be used at the election rallies and subsequently designed by the government officials who have been away from the ground realities since time immemorial.
I understand that criticizing the government is too easy a task in India. So, I have also come up with suggestions about the contours of how real Ayushman Bharat should look like and operate to have tangible effects on the country.
Ayushman Bharat has tried to reduce the paperwork by removing the cumbersome registration process for the beneficiaries. Ayushman Bharat has also removed the limit on family size and the standard inane health insurance clause of pre-existing illness. However, this is surely not enough.
Expand Ayushman Bharat
To start with, Ayushman Bharat should immediately include all Indians below 18 years and above 58 years, without any pre-conditions. For what good is a country who is unable to take of her future and her past?
To simplify further, Ayushman Bharat should include each and every Indian barring the people in the 30% tax bracket and the government staff. Actually, they can also be included. I do not think they will anyways opt for the incompetent government schemes. They will pay for themselves, why not include them anyway?
A scheme cannot be allowed to use the name of the country unless it is applicable to the entire country. The scheme is called Ayushman Bharat and it better apply for the whole country.
I understand that the costs will be huge and so will be the benefits that will far outweigh the costs.
If India wants a better future for her citizens, it is going to happen by including all Indians in Ayushman Bharat.
The only challenge will be to ensure that covering all citizens do not crowd out the poor.
Cover all ailments and all hospitals
Currently, Ayushman Bharat claims to cover most of the secondary and tertiary care services, but not all. I would propose that Ayushman Bharat is better served by coming up with a list of exclusions. It is better for the people to comprehend rather than the silly repetition of “coverage of most of the services”.
The home-page for Ayushman Bharat shows that the list of empanelled hospitals is under construction, even now! I suppose it would be easy if all the hospitals accept Ayushman Bharat patients, rather than doing cherry picking.
Customized rates and not standardized
I suppose why the hospitals are not willing to join Ayushman Bharat is that the government is paying them a standard rate. The government will pay the same price for an operation in a 10-bed hospital in Adilabad and an Apollo hospital in New Delhi.
If the government bureaucrats can apply themselves a bit and arrive at a base rate and a list of customised rates basis the facilities available – doctors, qualifications of support staff, staff:patient ratio, equipments available and of course the outcome in terms of a healthy patient; I do not see any reason why no hospital would not want to join the Ayushman Bharat.
In fact, the customised rates will also ensure that crowding out of the poor will not happen.
100% free diagnostic tests and primary care
One of the sure-shot ways to reduce the cost of Ayushman Bharat is to make the basic diagnostic tests 100% free of charge and the resultant session with a general medical practitioner.
If we are told about our medical conditions in advance, nobody would want to end up in the secondary and tertiary care, if we can help. We would want to make use of the preventive rather than the curative medicine.
Why would the government miss this basic feature?
Make better use of the 108 service
Currently, Ayushman Bharat focuses only on the secondary and the tertiary care. It does not care about how the destitute/primitive tribal groups/beggars etc are going to pay for the transport to the hospital?
Each state government has a sizeable fleet of ambulances under 108 services. They can be used to ferry regular patients in need and not just respond to an emergency.
Should the political leaders want to and should the government machinery want to apply them, there are enough ways and means to extend Ayushman Bharat to all the Indians.
Just that we should want to.