Context: Coronavirus infections in India have shot past 300,000, swelling the demand for medical care.
- The country’s healthcare infrastructure is creaking, especially in urban areas.
How COVID-19 disease is evolving in India?
- High infections: India has almost 20% of the world’s population which is highly mobile and dynamic in nature.
- The density of the population is also high in several pockets which leads to a higher number of infections in India.
- Low deaths: The number of deaths per 100,000 people is still fairly low (less than 0.6/100,000) and one of the lowest in the world.
The efficacy of lockdown as a strategy
- Provided reaction time: It has given states sufficient time to strengthen their health systems to respond to covid-19 by identifying health facilities for covid-19 care and equipping them well with ICU services, including ventilators and oxygen supply.
- Flattened the Covid Curve: If there would have been no lockdown, then the rate of rise in cases would have been much faster.
Role of Ayushman Bharat - PM Jan Arogya Yojana (PMJAY) in tackling the covid-19 pandemic -
- Testing: The National Health Authority (NHA) has put in place specific packages for testing and treatment of covid-19.
- Empanelled hospitals: It has also empaneled more than 1,500 hospitals recently to increase access to both covid-19 and more importantly, non-covid-19 health conditions.
- It has been empaneling the Indian Council of Medical Research (ICMR)-approved private labs directly for covid testing.
- Leveraging data: They are also using their large database to identify people who are at a high risk of mortality from covid infection, in particular —elderly people with co-morbidities.
- Identifying hotspots: NHA is also using daily hospitalization reports to see if there is a spike in respiratory or influenza-like illnesses in any part of the country. NHA alerts the local authorities about such spikes on a daily basis.
- Technology implementation
- Digital Empanelment of more labs and hospitals: NHA has brought on-board more labs (exclusively for covid testing) and hospitals through “HEM Lite", a simpler fast-tracked digital mechanism for swift empanelment on a temporary basis.
- Managing the tele-consultation for self-reported Aarogya Setu cases and PM-JAY high-risk beneficiaries.
- The NHA is using its call centre to manage the covid-19 helpline 1075.
Role of private sector healthcare
- In AB-PMJAY, the private sector is already an integral part, with close to 50% of the empaneled hospitals being private.
- For non-covid health facilities: As several hospitals have been converted into dedicated covid facilities, the need to continue providing critical non-covid health services, such as haemodialysis, cardiovascular procedures, and chemotherapy becomes even more important.
- The govt. Is ensuring timely reimbursement, sensitizing them on protocols and providing training support.
- Public-private partnership (PPP) models are aimed at strengthening the existing healthcare infrastructure, augmenting availability of new infrastructure especially in tier-2 and 3 cities and developing new technologies aimed at delivering a higher quality of healthcare.
- Pooled and mass testing : Currently, India is testing more than 150,000 samples in a day across 724 laboratories, of which 217 are private labs. It has Increased in terms of volume and geographical access.
- Pooled sampling can help in boosting the capacity. However, we do not need mass testing at this stage.
- Contract tracing in rural areas: The prevalence is still low so contact tracing, isolation of patients and early treatment are the critical components of our strategy.
- Strengthening our ICUs and health system so that they do not get overburdened.
- Kickstarting economy: We have to get back to work and adopt widely different ways of life to contain the risk of infection yet continue working.
- Behaviour change: This will involve massive behaviour change at individual and community levels, developing a new kind of civic understanding and engagement.
Ayushman Bharat is a two pronged approach towards Universal Healthcare.
- Health and Wellness centres - They will provide comprehensive Primary Health Care, free essential drugs and follow up of hospitalization cases. They will also conduct yoga sessions to promote wellness and have a much wider range of free drugs and diagnostics.
- The HWCs serve as the awareness, screening and referral link between patients and PMJAY.
- Pradhan Mantri Jan Arogya Yojana (PMJAY) - It provides a health protection cover of rupees 5 lakh per family per year to the bottom 40% of poor and vulnerable population for hospitalization expenses towards the treatment of serious illnesses.
Ayushman Bharat aims to offer financial risk protection to the beneficiary families through a system of demand led Healthcare initiative that meets their immediate hospitalization needs in a cashless manner.
- A National Health Authority (NHA) has been mandated to roll out and coordinate the programme.
- A cadre of frontline health service professionals called Pradhan Mantri Arogya Mitras (PMAMs) are trained to facilitate provision of treatment to beneficiaries at hospitals.
Considering the fact that states are at different levels of preparedness and have varying capacities the PM-JAY provides them with the flexibility to choose their implementation model which can be through Insurance, Trust or Mix mode.
- Insurance Mode - The state government appoints an insurer at a defined rate for taking over the financial risk of the beneficiaries.
- Trust Mode - The state government creates an agency which pays the claims of the hospitals as per actual utilisation. The risk of health protection lies with the state.
- Mixed Mode - The state uses a combination of insurance and trust modes generally where low-cost common procedure (secondary care) is managed by the insurer and high cost specialised procedures managed by the state trust.
PMJAY, being a centrally sponsored scheme is fully funded from the consolidated fund of India. The expenditure is shared between Central Government and state government as per the sharing instructions issued by the Ministry of Finance.