There is ‘an essential truth in the old saying that it takes a village to raise a child. The logic that the collaborative efforts of a community are required to teach a person all the skills they need comes to mind’ when considering India’s hugely ambitious target of rolling out the world’s largest government-funded health-care programme. It is only by drawing on all of the country’s expertise, and with government entities, the private sector, health-care providers, think tanks and citizens working together in partnership, that this hugely ambitious vision can be achieved. Thankfully, a number of healthy villages are forming right now in India and the era of universal health care is near.
Ever since the Ayushman Bharat, or the Pradhan Mantri Jan Arogya Yojana (PMJAY) initiative, was announced earlier this year, efforts are being expedited in the country to ensure that it becomes a reality. However, as States press ahead with the implementation of the programme, a bigger consideration that remains unclear is whether the ₹5 lakh medical insurance is an end-to-end health-care scheme. More importantly, is it viable to integrate primary, secondary and tertiary care? Given the highly fragmented and complex nature of the health-care infrastructure in the country, will States be successful in rolling out the programme that provides secondary and tertiary care within the insurance cap earmarked per family?
In my view, the initial years will provide valuable learning and insights that will help scale up the scheme. That said, it is also important to consider some of the previous affordable health-care programmes. A case in point is the Rashtriya Swasthya Bima Yojana (RSBY), the precursor of the PMJAY, which provides health coverage of ₹1 lakh per family. This is yet to be implemented in full, and if this is any indication, the PMJAY should look at creating opportunities for public and private health-care service providers to collaborate in a strategic manner which will ultimately make quality health care accessible and affordable.
According to the World Bank, 99% of India’s population cannot afford advance health-care services. Data from the British Medical Journal suggest that each year, 38 million Indians slip below the poverty line due to rising health-care costs, with average household expenditure amounting to approximately 6%.
Keeping this in mind, establishing foundations for collaboration with the private sector could be seen as an antidote to the lack of accessible and affordable health care. Another critical catalyst for collaboration is the PPP (public-private partnership) model. India has in the past demonstrated its ability to explore the PPP route in launching the National Dialysis Programme which provides treatment across several district hospitals in the country. In this context, the PMJAY is uniquely positioned to expand the scope, making it a true universal end-to-end health-care scheme, which the private sector has displayed great appetite for in the recent past. The PMJAY has as much potential to become a major beneficiary of this drive.
Furthermore, as the Indian private sector is making rapid strides towards social investments, it should come as no surprise that these companies, in keeping with their corporate social responsibility strategy, are eager to participate in achieving the ambitious target of improving the nation’s health indicators, which in its current form is stifling economic growth. This makes it logical for State governments to tap the private sector through a partnering model which would essentially help roll-out the PMJAY programme while offering opportunities to scale up.
While the applicability of some of these concepts may depend on many factors, each has the potential to bring India a step closer to being a truly health-confident nation. This is a time for the Central and State governments to be as inventive and persuasive as possible in what they can offer to the private sector to collaborate with in making the PMJAY a truly universal health-care programme.
Dr. Azad Moopen is the Founder Chairman and Managing Director of Aster DM Healthcare
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