As the AB-PMJAY purchasing health services for more than 50 crore population; it can set up prices effectively, influence quality of health services; incentivise hospitals to improve quality with differential rates; and enforce electronic data sharing by private hospitals. As the scale and ambition of the scheme with its target group larger than the combined population.
As there are also groups of detractors who are concerning; that the scheme either seeks to address a wrong problem or provide a wrong solution even if it aims to address the right problem. As address the ten most common concerns raised. While it is correct that prevention is better than cure, in real life both are needed. The policy challenge is not prevention vs cure but how to provide both prevention and cure. What can poor people be expected to do when faced with catastrophic health expenditure.
Quality of health services
Some people argue that the government should not use its limited resources for support services through the private sector. The private sector plays a critical role in health sector. We will need to leverage the capacity, financing, skills and energy of the private sector to provide services to millions of people who have hitherto not had any access to these quality services.
Some point out that government services are free, what then is the value addition by AB-PMJAY?While most states seek to provide free healthcare through government hospitals, in reality, patients still have to spend a lot from their pocket. In many cases, they have to get the diagnostic services, drugs and implants from outside as they are often not available in the hospitals.
Two, even in states using insurance companies, they have put a claw-back clause in their contracts such that insurance companies can keep only 15% of total premium. Three, it has been observed that due to competition, insurance companies are quoting competitive premium. Demand creates its own supply and supply cannot be created without demand. Due to the portability of services, beneficiaries of the states also gain from the nationwide network of hospitals.
The new demand will be met through excess existing capacity in the private sector and more efficient use of the current capacity in the short run. Ayushman Bharat has put India on an irreversible path towards universal healthcare. The scheme will keep evolving, taking into account the experience of evidence generated from its implementation. Given the highest level of political support for these reforms, failure is not an option.