THE GIST of Editorial for UPSC Exams : 21 MARCH 2019 (In Ayushman Bharat, primary and secondary healthcare complement each other (Indian Express))

In Ayushman Bharat, primary and secondary healthcare complement each other (Indian Express)

Mains Paper 2: Governance
Prelims level: Ayushman Bharat
Mains level: Ayushman Bharat implementation and impacts

Context

•  Ayushman Bharat promotes secondary and tertiary care at the cost of primary care.
•  The Perception of all health needs in India relate only to primary care and there is no need to expand support for tertiary care.
•  The Perception of Ayushman Bharat is taking away resources from primary care and benefiting big private hospitals.
•  Even if we do our best to promote good health, there will still be a critical need for tertiary care and secondary care.

Non-communicable diseases

•  The diseases related to old age will increase even among the poor strong primary healthcare system requires an equally strong secondary and tertiary healthcare system.
•  Secondary and tertiary care in the country is largely provided by private sector  inaccessible to the poor Ayushman Bharat has changed that.
•  Ayushman Bharat has two legs.
•  The Pradhan Mantri Jan Arogya Yojana (PMJAY), covers more than 50 crore people in the country the poorest against serious illnesses.
•  To strengthen primary healthcare upgrade more than 1.5 lakh health facilities to health and wellness Centres (HWC).
•  The resources spent on the PMJAY component of Ayushman Bharat are still a very small proportion of the entire health budget.
•  A major portion of the health budget is spent on primary care and secondary care, almost entirely focused on public sector supply of the healthcare services.
•  The 2017 Health Policy is increasing the health sector allocation to 2.5 per cent of the GDP for decades, hovered at around 1 per cent of the GDP.

High level political commitment for the health sector

•  If this trend continues, we should be able to provide much needed tertiary care for the poor without compromising the support for primary healthcare.
•  States have freedom to choose the implementation model; in fact, most states, including all the large ones (UP, Bihar, MP, AP) have decided to use a trust model where the government directly purchases healthcare services from the hospitals without using any insurance company.
•  Of the states that are using the insurance model most have resorted to public sector insurance companies.

Conclusion

•  Finally, the scheme has a “claw-back” clause in its model contract, which limits the margin of the insurance companies to only 15 per cent they will have to return the government any extra margin.
•  This margin includes administrative expenses and therefore the potential profit is much less than 15 per cent, while the loss for the company could be quite high.
•  The scheme’s design ensures that private sector hospitals do not unduly receive a large proportion of financial resources. The payment for services is based on fixed package rate for each procedure, which is largely based on the marginal cost.
•  The scheme also has strong features for preventing, mitigating and deterring fraud and abuse.

Online Coaching for UPSC PRE Exam

General Studies Pre. Cum Mains Study Materials

Prelims Questions:

Q1. Which of these are constitutional provisions?
1. Duties of prime minister to furnish required information to the president
2. Power of president to consult Supreme Court
3. Special provisions with respect to Delhi

Select the correct answer using the codes below.

a) 1 and 2 only
b) 2 only
c) 1 and 3 only
d) 1, 2 and 3

Answer: D
Mains Questions:
Q.1) Discuss the promises and challenges in implementation of a bold experiment in health sector named Ayushman Bharat.