India Today – October 08, 2018

16 INDIA TODAY OCTOBER 8, 2018

receiving 80 per cent of claims money in Chhattisgarh,
over70percentinAndhraPradesh and Maharash-
tra and more than 60 per cent in Tamil Nadu. These
hospitals also charge patients on the sly. And in this
scheme of things, both the public and the government
lose while private hospitals profit.
The PMJAY will damage public healthcare
delivery.Notonlywilllessmoney be now available
to build/improve government hospitals, government
doctorswillcontinuetorefertheir patients to private
hospitals for a ‘cut’.
India should learn from developing countries who
have achieved universal healthcare. Thailand is such an
example. The Thai healthcare system is adapted from
the UK model but tweaked to suit their context. It is
built on a strong public health system for primary and
secondary healthcare. More than 75 per cent of hospi-
talisation is in government facilities. Private hospitals
are used judiciously for high-end tertiary care. Instead
of insurance, they have innovative public financing,
which is responsive to the needs of different populations
and areas. The Thai government spends 3 per cent of its
GDP on health; India,
by comparison, spends
just over 1 per cent.
The upgradation of
150,000 Health Sub-
Centres and PHCs as
‘Health and Wellness
Centres’ (HWCs) under
Ayushman Bharat is an
opportunity for better
primary healthcare.
But it needs more than
the measly Rs 1,
crore budgeted within
the limited National
Health Mission funds. It needs closer to Rs 2.5 lakh
crore at Rs 17 lakh per HWC. The Community Health
Centres and District Hospitals can be strengthened too.
Our approach to human resources for health needs to
change: more local youth need to be trained as health-
care providers to serve in their districts. A few private
hospitals could be empanelled for limited high-end
services through referrals from district hospitals.
The PMJAY mimics the US health system, which
is expensive with poor outcomes; the Thai model
would have served India better. Far from being the
panacea for India’s healthcare ills, the PMJAY is likely
to exacerbate them and be an even bigger disaster
than the previous health insurance schemes. ■

Sulakshana Nandi is a public health researcher and

National Co-convenor of the Jan Swasthya Abhiyan

(People’s Health Movement India)

UPFRONT

The PMJAY

will damage

public

healthcare

delivery. It

mimics the US

health system,

which is costly

with poor

outcomes

‘Modicare’:

Boon or Illusion?

PM Modi launched what is being touted as the world ’s largest

government healthcare scheme on September 23, a collaboration

between the Centre and states to provide healthcare to over 500

million people. Critics describe it as a smokescreen that gives the

impression of universal coverage without making meaningful space

in the budget for such a far-reaching scheme. Still, no one would

deny that Indian governments have thus far failed to make necessary

investments in health. Maybe we should seek solace in the fact that

the need for universal healthcare has been recognised even though

much about the Pradhan Mantri Jan Arogya Yojana—and the measly

allocation to build primary care centres under the Ayushman

Bharat plan—remains uncertain

INDEX

107 MILLION

Families in 445

districts across 26

states identified as

recipients of the

PMJAY scheme,

based on the 2011

Socio-Economic

Caste Census.

Over 500 million

individuals

expected to benefit

`

1,

CRORE

to build

150,000 primary

healthcare centres

under Ayushman

Bharat, or just

Rs 80,000 per centre

1,

Packages in PMJAY for some 20

specialised surgeries, including

coronary bypasses and knee

replacements, at rates 15-20%

lower than under another

central government scheme

1

%

Of Rs 5 lakh annual allocation

spent by each recipient, say

critics, would cost Rs 50,

crore. While Rs 10,000 crore

translates to Rs 1,000 per

family; or Rs 200 per person

`

14,

Average cost of hospitalisation in rural India and Rs 24,436 in urban

areas in 2014, says National Sample Survey Oce

`

5 LAKH

Annual coverage

to be provided to

each beneficiary,

including

reimbursements

for hospital and

drug charges

2 days before

and during

hospitalisation,

and 15 days after

`

2,

CRORE

Allocated in 2018-

budget for PMJAY;

Rs 10,000 crore

earmarked over

the next 2 years

60

%

Of PMJAY costs to be borne

by the Centre, 40% by states.

5 states and Union territories

—Kerala, Punjab, Odisha,

Telangana, Delhi—opt out, saying

their existing schemes

are better

1.6 MILLION

People die in India every year

because of poor healthcare.

The worldwide total is 5

million, estimates a new study

published in the Lancet

this month