Ayushman Bharat or the Pradhan Mantri Jan Arogya Yojana (PM-JAY) is possibly the world’s largest health insurance scheme implemented by the Government of India since 2018. The scheme allows economically challenged Indian citizens to claim free secondary and tertiary hospitalization insurance benefits for up to ₹5,00,000 (USD 7,295.50) per family on an annual basis.
Currently, the implementation of the scheme is dependent on the Memorandums of Understanding (MoUs) and notifications that are signed between the States and the Center. However, there is growing dialogue with the private healthcare sector to volunteer to support this Central Government initiative. Additionally, the Government has started to draft legislation for this initiative. Leading private healthcare establishments, such as Dr. Devi Shetty’s hospital chains, are already a part of this visionary scheme. As there is growing pressure on the private sector to engage in complementary Central Government healthcare benefits for the economically challenged sections of society, the cash incentives for disease management in such cases would be reduced drastically. This scheme will also lead to the development and implementation of new initiatives to ensure improved health conditions for the economically challenged sections of the country while also enabling economically optimized private healthcare practices. Frost & Sullivan believes that this national insurance scheme has the potential to enable a paradigm shift from the traditional sick care to the health care model for the financially challenged sections of society.
However, the large-scale implementation of this game-changing healthcare initiative is currently hindered by technological setbacks. This led the Indian Government to look towards South Korea for inspiration. South Korea was one of the first countries to implement universal healthcare through a Parliamentary Act and is currently ranked first for healthcare access across the high-income Organization for Economic Co-operation and Development (OECD) countries. The key success factors for South Korea’s Universal Health Care Program have been the use of paperless data management systems, electronic healthcare records (EHRs), and digital review and reimbursement platforms that have a very short turnaround time. Currently, the Indian Government is considering the transition towards the use of shared digital platforms for seamless integration of hospital health records that will be linked to patients’ Aadhar cards, India’s unique identification cards. As South Korea struggles with healthcare identity checks, it looks towards India for inspiration in this regard. Such cross-country healthcare dialogues will surely help in establishing best practices across national wellness programs.
The beneficiaries of Ayushman Bharat Yojana will be identified using the Socio-Economic Caste Census (SECC) database or an active Rashtriya Swasthya Bima Yojna (RSBY) card or the deprivation categories (D1 to D7). It is interesting to note that girl children, women, and senior citizens will be prioritized for eligibility under this scheme. Not surprisingly, this groundbreaking scheme averaged 5,000 claims daily during the first 100 days after its launch. As of 2nd February 2019, the number of beneficiaries under the PM-JAY totaled 10,94,254 and the total number of PM-JAY empaneled hospitals was 14,728, which also includes 7,299 private healthcare establishments. Recent reports revealed that Gujarat had filed the highest number of claims valued at approximately ₹8.62 billion (0.13 billion USD) covering approximately 8 million families. Jammu & Kashmir (J&K), which continues to be under President’s rule, surprisingly filed over 20,000 claims valued at approximately ₹129 million (1.88 million USD). These statistics highlight the significance of the scheme even during times of insurgency. The Union Ministry of Health and Family Welfare is actively reaching out to the Chief Ministers of West Bengal, Odisha, Delhi, and Telangana to encourage them to opt for PM-JAY, which may lead to greater healthcare benefits across these regions.
This initiative by Government of India is likely to drive new growth opportunities for the Indian healthcare industry through new product and service innovations and will help establish a global standard for healthcare practices post successful implementation. The Ayushman Bharat scheme will also trigger technology convergence across the digital healthcare landscape and accelerate new software and medical technology developments. Frost & Sullivan will be closely following this story for the latest advancements that are poised to become a transformational force in the pharmaceutical, medical device, and healthcare service clusters.
Frost & Sullivan believes that India is suitably positioned to lead a paradigm shift from sick care to the health care approach through the large-scale implementation of the Ayushman Bharat scheme. The scheme is likely to drive greater private-public healthcare collaborations. The Ayushman Bharat scheme, if implemented successfully, will provide a new ray of hope for several million citizens who are currently deprived of quality healthcare services in the country.
The author is Vandana Iyer, Team Leader, Health & Wellness – TechVision, Frost & Sullivan. – Medical Buyer Bureau