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Ayushman Bharat 2.0: A Sustainable Consensus Between Centre And States

Limited access, unavailability, suboptimal or unknown quality of health services, and high out-of-pocket expenditure (OOPE) are some key challenges in the healthcare sector.

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After a year of the Prime Minister's overarching health scheme Ayushmaan Bharat, a road map including the interaction of all the stakeholders, bringing in more supply chain efficiency and data creation, can help in disseminating the scheme benefits to all the households.    

Limited access, unavailability, suboptimal or unknown quality of health services, and high out-of-pocket expenditure (OOPE) are some key challenges in the healthcare sector.
 These challenges exist alongside a global discourse to achieve universal health coverage (UHC) – increasing access to quality healthcare services at affordable cost, by all people; and in times of fast economic growth in India. Though India’s National Health policy-2017 (NHP2017) is fully aligned with global discourse and has the goal to achieve UHC, outside the policy discourses, health is often not considered high on the priorities by the political leadership and is traditionally been underfunded. 

Health expenditure is estimated to contribute to 3.6% and 2.9% of rural and urban poverty, respectively.  Annually, an estimated 60 to 80 million people in India either fall into poverty or get deeper into poverty (if already below poverty line) due to health-related expenditures.  Ayushman Bharat Program (ABP) has two components: (a) delivering comprehensive primary health care by establishing 150,000 health and wellness centers (HWCs) by the year 2022, and (b) Providing financial protection for secondary and tertiary level hospitalization as part of National Health Protection Scheme (NHPS). The ABP with two components intends to provide services with continuum across three levels of care and brings back the attention on the delivery of an entire range of preventive, promotive, curative, diagnostic, rehabilitative and palliative care services. 

At the Hospital Summit and Awards organized by BW Healthcare, the first session titled ' Ayushman Bharat 2.0- Deciphering the Next Steps' had a wonderful panel which included Dr Azad Moopen, Funder Chairman & Managing Director, Aster DM Healthcare; Dr Dinesh Arora, Deputy CEO, National Health Agency; Dr Alok Roy, Chairman & Managing Director, Medica Super Speciality Hospital; Dr Malti Jaiswal, Senior Consultant, World Bank; Dr Om Manchanda, CEO, Dr Lal PathLabs and Amrita Agarwal, National Lead, Health Systems Design, Bill & Melinda Gates Foundation. The panel was moderated by Dr. Rana Mehta, partner Leader, Healthcare PwC (Chair). 

Dr. Rana Mehta commenced the panel discussion saying that 'Health is the foundational investment for the economy.'   Ayushmaan Bharat will take time and both public and private sector collectively have to participate to complete the vision of Ayushmaan Bharat. Dr. Alok initiated saying that the irrespective of all the hurdles there has been some positive impact through the scheme. He also added that the government hospitals are seeing a huge upside in terms of revenue because they have never seen the side of money. However, private hospitals are quite standardized. We cannot compare a small 2-bed government hospital and to 4-bed private hospitals because government hospitals are substandard. Also, serious attention should be made towards auditing in the hospitals as well.   

Amrita is a veteran in the industry informed that Ayushman Bharat 1.0 with a digital data structure had a great start. The start of any change happens through discussion. Ayushman Bharat 2.0 is meant on how can we leverage and involve all the stakeholders and magnate coverage. There is a lot to be done with in terms of evolving the healthcare financing system.    

Dr. Om heading a diagnostic company added that Ayushman Bharat is indeed a new road ahead but we still need to focus on creating a new ecosystem while fixing it also. Diagnostic can play a big role in addressing the issues of wellness along with the collaboration with hospitals. 

Malti who has actually witnessed the transformation closely informs that 22 lakh people have been benefitted while they have been hospitalised and have been treated cashless. Ayushman Bharat has been a game-changer because, considering the fact of a diversified culture of states, we have been trying to address the challenges of each state individually.  Ayushman Bharat 1.0 had a good beginning but we still haven't been able to reach everyone. The main task of 2.0 is to increase the participation of private players, bring in more awareness of the beneficiaries and also bring in more efficiency. We are attempting to improve the digital setup and IT structure for all the stakeholders and the beneficiaries, especially for the payments. It's too early to make any judgment. We also lack in the creation of data and the availability of data can help us understand the problems and address the challenges appropriately. 

Dr. Moopen opines that considering all the factors, we need to address the issues at the supply side as well. However, just like how GST has invaded all the stakeholders, we also need to bring in everyone from all the states and involve the Centre as well during the conversations. Hence, more consensus between state and agency is really important. 

 Dr. Dinesh, at the helm of National Health Agency, informs that we have been working on the ground level while thinking, interacting and promising to bring in reforms. After a year, we shall follow the same pattern of involving the private players and bring a fully developed health infrastructure to people's homes.   

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