a published journal's presentation by Dr. Chetan sharma

1. Ayushman bharat initiative:what
we stand to gain or loose
Harsh Bakshi, Rashmi Sharma, Pradeep Kumar
Presented by
Dr. Chetan Sharma

2. • Right to health = Basic human right
• After Bhore committee report(1946),
central/state govt put their effort to provide
health through 3 tier health care system &
various health programmes.
• Success in eradication of smallpox,
dracunculiasis, regional elimination of leprosy,
neonatal tetanus, controlling disease such as
malaria/other vector borne disease, & reduction
in maternal/infant mortality are few
achievement.

3. • However, system also failed in providing
quality curative & rehabilitative care to
masses, especially in remote areas.
• Thus, in recent time steps are taken to address
the issue – National Health Policy(NHP) 2017
& Ayushman Bharat Initiative
• Both of these are critical to attain universal
health coverage(UHC)

4. What is Ayushman Bharat?
• In budget speech of 2018, the Ayushman
Bharat for a new India 2022 was announced ,
• It includes 2 major initiative- creation of
health and wellness centers(HWCs) and
National Health Protection Scheme(NHPS).*

5. Health & wellness center scheme
• A larger7 comprehensive package of primary
health care will be delivered by upgrading sub
centers(SCs) to HWCs.
• HWCs will have point of care, wellness room
for yoga, physiotherapy & group meetings,
consultation space with full privacy, free
diagnostics & pharmacy, facilities for
telemedicine & waiting area of 30 plus
persons.

6. • It will also have common ophthalmic & ENT
problem, oral Health, Mental health ailments,
elderly & palliative health, emergency medical
services, management of communicable &
non communicable diseases and general opd,
besides reproductive, maternal, neonatal,
child & adolescent health services.
• It will also create electronic health record with
it system .

7. Ayushman Bharat National Health
Protection Scheme
• Centrally sponsored flagship scheme.
• Aims to provide annual health cover upt o Rs 5
lakhs to vulnerable 10 crores families based
on socioeconomic & caste census database.
• It will provide a cashless cover for identified
secondary/tertiary treatments, in
public/empaneled private facilities without
any cap on family size & age.

8. • All pre existing conditions will be covered from
day one of policy.
• Benefit will also cover pre & post
hospitalisation expenses & transport
allowance.*
• NHPS will subsume ongoing centrally
sponsored schemes eg Rashtriya Swasthya
Bima Yojna(RSBY)& Senior Citizen Health
Insurance Scheme.

9. Critical areas under Health & Wellness
Centers Scheme
• 1. budget under HWC is 1200 croes for
upgradationof 1,50,000 SC.*it isalmost 80,000
per SC.
• It is still grossly insufficient to meet the logistics,
Human resources & overhaul requirement of
sevices.
• 2. adding more n more service to grass root level
may results in under serving of their primary
objectives(promotive & preventive)& ineffectively
subserve the added responsibilities.

10. • 3. Huge shortage of specialist doctors & other
support staff.*
• Up gradation of sub centers(SCs) to Health &
Wellness Centers (HWCs) without matching
referral setup can be counterproductive.

11. Critical areas under Ayushman Bharat
National Health Protection Scheme
• 1.NHP 2017aims to ensure UHC & reinforce
the trust in public health care system by
strengthening & expanding the services which
will increase health expenditure from 1.15%
to 2.5% by 2025.*
• 2. annual premium of AB NHPS would be
around Rs. 2000/family to start with & would
entail an expenditure of RS 20,000 crores.*

12. • This is in contrast to a similar Rashtriya Swasthya
Suraksha Yojna proposed in budget 2016 worth
Rs 1,500 crore, to provide an annual cover of Rs 1
lakh per economically weaker household.*
• AB-NHPS, with five times the cover & higher
number of beneficiaries, has been rolled out with
allocation of Rs 2,000 crores only.this gape is
proposed to be filled by contribution of state.

13. • 3. it will be a challenge to achieve desired
goals unless all different state agree to
implement the scheme.
• The state contribution is expected to be 40% .
• The situation will be complicated as many
states are running their own health insurance
scheme.

14. • 4. shortfall for rural public health facilities,
calculated using prescribed norms on the
basis of rural population (from census 2011),
is 19% for SCs, 22% for primary health
centers(PHC),& 30% for CHCs.*
• This shortfall is compounded by shocking
shortage for specialist doctors.

15. • 5. NHPS currently, focuses on secondary &
tertiary care services which are concentrated
in urban & unavailable in rural areas. Hence it
will not able to check the movement of
patient from rural areas.

16. conclusion
• 1. as community medicine specialist, we would say,
NHPS, to begin with is a misnomer. It will not provide
health care but only medical care & that too in patient
care largely at private/corporate hospitals.
• 2. allocation for both NHPS & HWC schemes are not
adequate, and if the failures documented for RSBY are
any indication, the NHPS is likely to result in over
treatment or unnecessary surgeries.*
• Hence, if the scheme is used, premium rates are sure
to increase.

17. • 3. success of scheme will depend upon
focusing on health & not merely sickness.
• Reducing disease burden through robust
primary care, focus on allied determinants of
health, quality outdoor & indoor services in
public hospital & incorporation of indigenous
school of medicine